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"?

“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? “

Australia also has universal health care but it’s efficacy and efficiency is dependent on lots of factors, depending on where you live. There aren’t subspecialists in the middle of the bush!

With regard to mental health care I have some insight to how it works for children where I live (this includes behavioural issues as well).

• there is a public mental health inpatient ward
• there is an outpatient based CYMHS (Child and Youth Mental Health Care Service). This is awesome In terms of assessment, input and support if you’re accepted and most people only seem to wait a few weeks before initial contact. However, their intake criteria are strict.

• there are private child and adolescent psychiatrists

• in the community there are private child psychologists, many with different areas of focus. Some are educational psychologists, some can do full autism assessments, school visits etc as well as clinical psychologists. The government pays most of the consultation fee but there’s a gap of around 50-60 dollars. You get 10 sessions a year (each year, not as a one off) under this scheme. This applies to adults as well. There are a lot of psychologists but some are more popular than others.

• However, in order to increase accessibility to psychologists for people who can’t afford the gap fee the same psychologists can also be accesssed free under a different program if you have a low income or your child has a chronic condition. Similarly, there are 10 sessions a year under this. This applies for children under 12 years. For over 12 year olds and adults the criteria are different (stricter).

• for children with specific diagnoses (ASD, mainly) free access to psychologists is part of the early intervention funding package, although it’s messy at the moment as the funding packages are switching over to the NDIS.

From a pragmatic perspective, if, for example, my 11 year old struggled with anxiety but was still functioning OK (going to school, doing activities etc) I probably wouldn’t be eligible for CYMHS. I would have to go to my GP who isn’t hard to get an appt with and ask for a referral under the Mental Health Care Plan to a child psychologist I had chosen. Depending on the psychologist I would expect to have an appt within a month. She would have 10 sessions. If I couldn’t afford the gap my GP would refer under the other program but most of the psychologists are the same.

• there are also free youth health clinics for children and young people aged 12-25 with a focus on mental health and sexual health as well as practical support. They have psychologists and medical doctors.

It’s not perfect but the access to psychologists is a strength, I think. I’m not sure how it compares to the NHS, obviously.

Another one here perplexed by the claim an Australian dr asked if someone could afford treatment.

Hospital treatment as an in patient is free.
I needed a minor op under day surgery. My GP asked if I had insurance. No? I had to wait 2 weeks and was the last patient of the day,(having got there at 8am) but someone has to be last. I think the private patients were seen first.

you can chose to have physio, chiro etc and you pay for these- and claim on your insurance if you have it.

I recently had a suspected broken bone. GP made me an appointment for hours later at an imaging office and he got the results the next day. All free and v efficient.

@Graphista We have premium ambulance cover, for three of us its about $70 a year. When we needed an ambulance we didn't have to pay up front, the bill was covered in full by insurance. So that's about 13 pounds a year each.

Graphista "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."

The thing is that there isn't one answer for the whole of the USA, just as there isn't one answer for all of the EU (or for that matter even all of the UK). The type of coverage available at every level can vary vastly from one State to the next. I live in California which is by all accounts one of the better States, and my brother lives in New York and I manage his medical bills, so I can speak to those two States with experience and knowledge. I also have a severely mentally ill (+ rare genetic disease) ds so have quite a bit of experience with all aspects of the health system both here and in the UK (and Italy too). Things have changed enormously in the USA (for the better) since the introduction of the Affordable Care Act.

I will describe what it looks like now, because it's a bit silly to refer to how it was before as that is no longer and it's much better now. (Many of the horror stories are pre-Affordable Care Act) 1) "close to" free at the point of delivery means pretty much that. For a recent operation at one of the best hospitals in the country with a top doctor, that involved an overnight stay in the hospital, the portion that my DF had to pay was under $50. The cost of my DM and DF's multiple medications at delivery is approximately $20/month total. My parents have no cost Medi-Care (which all over 65's have as long as they enroll) + a supplemental retiree health insurance which they pay $300 a month or so for in premiums (cost is dependent on income)...there are a variety of options for the supplemental insurance for the elderly depending on income level.

2) For someone "like you" with disabilities (including mental health because since the Mental Health Parity Act, mental health has to be treated like any other illness) depending on your age and your income (some people who don't work, still have income from other sources) you would be automatically (as long as you enroll) covered by a no cost (for premiums) insurance like Medicaid (for the low income or disabled) or Medicare (for the elderly or disabled) or both. Your cost at the point of delivery would be free. You could also supplement the coverage with a private insurance (which I do for my ds) which looks pretty similar to what happens in the UK when you purchase private insurance...it allows you to go to a wider variety of providers, get seen more quickly and has most importantly for us, better non-crisis mental health care. Medicaid would cover a hospitalization and all the medications, but wouldn't cover intensive outpatient or non-crisis residential treatment which the private insurance would cover. This is changing too and Medicaid coverage for non crisis mental health care is getting much much better. I don't know what Medicare's coverage is like, but it's definitely better than Medicaid.

The most difficult part is navigating the system and understanding what you are entitled to and accessing that. That too is getting better. I have seen a huge improvement in the 4 years that the Affordable Care Act has been around.

There are also other agencies that give support financially and logistically for the disabled. For example, my ds will be getting his vocational school paid for and assistance in getting a job that can accommodate his disabilities through a government agency.

I did not access the Mental Health part of the NHS when I lived there, so am going off what I read on Mumsnet and in the news....I think that what's available at any income level here in California (bear in mind that this is not the case everywhere in the US) is lightyears ahead of what is currently available in the UK.

Another recent example in Australia. My 3 month old had bronchiolitis.

• He started looking sick late Tuesday afternoon.
• Booked online for a GP appointment. Our GP finishes work at 5pm, so we booked with another in the practice who works until 8pm
• GP clinic bulk bills (so we don't pay at point of service) on weekdays for adults and at all times for children so the appointment was free.
• Check in at touchscreen kiosk. There are receptionists on if you can't use the touchscreen
• Dr was only about 5-10 minutes late, and lovely
• Recommended we take ds to emergency just as a precaution due to his medical history
• Took us about 45mins to get a bed. Waiting room was calm and quiet. Dr saw him within the hour after that and took a detailed history. Called paed team to get second opinion, but warned they were very busy that night
• Paed team weren't free after a few hours, but ds had improved so Dr said he could discharge us. I was asked if I would be comfortable and given the option of staying. Given clear guidelines on when to come back. As we were leaving I saw the neonatal ambulance parked out the front, which I guess is why the Paed team were delayed.
• DS became worse the following morning. We went back to emergency. Wait times were similar
• 2 paeds were there to review after about 2-3 hours. They said I was right to bring him in, but he could be managed at home. They said there was a bed available for him in paediatrics if I was too anxious, but I decifed to head home
• Everyone was professional and friendly, although clearly very busy. Morale seemed

pretty good.

• Got to take a digital thermometer home with me because it couldn't be reused. DH dropped me off so I didn't even pay for parking. So technically I came out at a profit!

NHS isn't free! It is free for people who can't work, who couldn't be ever bothered to work but for the rest of us you pay for it through your taxes and NI.

And it is a substandard health system, just barely good enough, and it is wasteful.

Ok...and my not so similar to QuickGetTheEggplants 's experience was when ds was 3 months and had a fever of 105 and was all floppy and lethargic, so we took him to our local A&E room (NW London) where they asked me why I had brought him there and not called his GP (uh because GP didn't do home visits and 105 combined with floppy and lethargic seemed pretty serious for a 3 months old). I explained that I was pretty sure it was an ear infection (because this was his third one in 3 months), but needed a doctor to check that it was that (and not meningitis) and prescribe the high level of ibuprofen he needed the previous 2 times to bring the fever down. We sat in the waiting room for 4 hours while they tried to find a medical professional who "knew how to check the ear of a newborn" (I kid you not). At some point during those 4 hours they decided that it might be a urinary tract infection although there were no other indicators of that (perhaps because they did have someone who knew how to put a dipstick in a cup of pee) and handed me a cup and told me to get him to pee into it. And then yelled at me for not producing the requested urine sample.
Ok...I agree that I didn't pay for the visit at the point of delivery, but if it had been meningitis, my ds could have died in the 4 hours it took them to produce someone qualified to examine him. I don't think this is what adequate healthcare should look like.

Gwen - that may be true TO A DEGREE but often it's not them following guidelines at all. It's arrogance and not listening to patients.

In 14 years of reporting textbook endo symptoms not once was I referred to a gynaecologist by an nhs GP - despite guidelines for many years saying otherwise and other sufferers are STILL having the same problem.

This is not limited to gynae issues either. Plenty of examples on my thread here:

https://www.mumsnet.com/Talk/amiibeingunreasonable/3402449-Aibu-to-ask-you-to-tell-me-your-experiences-of-being-dismissed-by-medics-as-a-sick-woman-I-promise-to-listen

Nolongersurprised - whoa! 10 sessions that isn't many, that's less than one a month! How does it compare to nhs? I am not familiar with camhs (child and adolescent mh services) but as a long term mentally ill person myself I have free medication, I've had free psychotherapy on a few occasions and certainly not limited to 10 sessions! Currently I see my cpn (community psychiatric nurse) once a fortnight in my home (as I'm currently housebound agoraphobic as one of my conditions) she is working with me to find the right meds (I became allergic to previous ones that worked) to find methods to improve my sleep and appetite, to overcome the OCD that is the main issue and cause of the other issues. I've been seeing her over a year as there was a crisis for me last year (external causes) which sort of partly recovered from then something else happened and that set me right back! When I'm able to leave the house again she wants to arrange more psychotherapy for me - things have gone wrong in the past which lead to interruptions in my continuity of care (not mh teams fault, due to changes in policy that came from "on high"). Frankly if all I could access was 10 sessions of psychotherapy a year I'd likely be an inpatient or dead! No exaggeration.

As someone who is on benefits and on the old system at that and it just about covers my costs, I'm DREADING the switch to UC, I also think saying "only £13 a year each" for ambulance cover, when we have people working full time in this country who can't afford to eat, is not recognising that this could well be impossible for many families.

"The thing is that there isn't one answer for the whole of the USA" even if those posters had answered regarding their state or region that would've been something.

I'm glad access and provision is much improved, in some states at least? But again if I had to pay for my meds that would make life extremely difficult for me, as in I think I'd have to cut down on something like food or heating - and I already only have the heating on when dd is home to save money.

I'm grateful to have the support I do but certainly particularly on the physical ailment side of things weirdly - I know many have had similar difficulties with mh side - it could be much improved and I really do feel certain improvements would actually save money.

graphista you asked about access to care for the mentally ill and I outlined starting points in the community. Of course there’s more for those adults and children under community mental health services.

As per my post community mental health care services such as CYMHS are fantastic but harder to get into and the 10 psychology sessions a year are very easily accessed for people who are functioning ok but still need help with low level anxiety.

If that's for people with lower level difficulties fair enough but I don't feel that was clear in the initial post on the subject.

Yes, lower level so not eligible for community psychiatric services. Personally, I think it’s pretty good. I get the mn impression that community psychology input is hard to access for children with behavioural difficulties, learning difficulties, anxiety etc.

People who won't hear anything negative said about the NHS are (in general) the kinds of people who have never lived in another country, and who believe everything they have been told about what things are like in other countries. It is a defense mechanism: they are uneasy on some level about the fact that they really don't KNOW, and it is easier to simply shout louder that one's own system is best.

As an American expat, I have been appalled by the poor service provided by the NHS. It is shockingly bad.

I have stopped trying to tell people in the UK that, as a young adult with no health insurance in the US, I was still able to access free care at a clinic. (But the service at that free clinic in America was also better than anything I've experienced with the NHS).

graphista sorry I wasn't clear. You would not have to pay for your meds.

Fuck tons of misinformation about the Australian system on here from non-Australians. No shock, really
I'm not surprised either.

Yes in Australia you pay for an ambulance call out
It's free in some states.

America was alway the entire continent, but seems generally to now just mean the United States. Are we comparing to the medical treatment in the entire continent of America or just The United States?

As United States comes 4th on the list for infant mortality, but Chile and Mexico are just above, not great stats for America

ivykaty44 I don't think anyone in this conversation is confounding the continent of America with the USA.

Infant mortality rates are complicated. They are actually calculated completely differently in different countries (data.oecd.org/healthstat/infant-mortality-rates.htm), so problematic to use infant mortality as a comparison of quality of healthcare as the OECD who publish the rates very clearly state in their description of the information.

My husband is still alive thanks to the NHS.....that says it all and I am very grateful for their wonderful care.

NHS saved my life in February, thanks to the vigilant staff in Winchester Hospital (GP was a 'take 2 paracetamol and come back in 2 days if no better'). Subsequent to that I have had excellent service from a different GP in the surgery.

However, I know the NHS is struggling. This is not down to money, it is down to where it is spent. That is a management issue.

I have lived in Germany, and Cyprus. Gave birth to my daughter in Germany. It was an excellent experience. My daughter had her tonsils out in Cyprus at 2, the staff were excellent as were the referral times.

For those who say 'you always get those that give glowing reports of the NHS because they saved their/relatives/friends life'. Of course those people will, because they might not have lived. You will probably find it is the staff that they appreciate more than the service itself though.

How does the world health organisation rate these countries?

Well said , everything you point out is spot on ! It's because people are frightened of the thought police they don't say what they think !

Most staff care very much but feel demoralised

Bmw6 not the Welsh or Scottish ,they run their own !

We Brits love to moan but we also love our NHS and will defend it to people that say we should all go private, we're weird like that 😂

How much is paid in contributions in these wonder free health services I wonder. Perhaps there is a better way too in managong those who use A & E unnecessarily. Needed healthcare in USA, first asked for insurance details then credit card details. This was emergency at a hospital. Our NHS is creaking due to lack of staff, and being too tolerant of those who abuse it.

IVF .... that old chestnut .... always used by those who have never needed it