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June, 10th 2009

NHS reality-check

– Liz Mair

I've been a longstanding critic of Britain's NHS, having been a patient within the system for the roughly 10 years that I lived in the UK and having been in a position to read, watch and hear the barrage of stories pointing out real flaws in the NHS system both firsthand and via news reports during the time I lived there.

So, it disturbs me a little that some out there seem to think the NHS presents a model worthy of consideration for emulation as part of the debate over health care reform in the US.  Yes, I understand that President Obama is not proposing that we institute an NHS as a solution to our health care problems (the NHS, remember, isn't just single-payer, something that, as David Sirota points out, Obama once supported and which he conjectures he still supports, it's actually government control of most health care provision).  However, as my good friend Phil Klein writes at the Spectator blog, health care legislation emanating from the (Democratic-controlled) Senate, under the leadership of Ted Kennedy, does say that health care exchanges (to be run by states, but apparently funded at least partially with federal monies) "shall include a public health insurance option."  This note, per Phil, appears on page 43 of the legislation, if you want to check it out.  The point here is, though, that this sounds to at least some people, including Phil, like a way of "migrating more people to government health care over time."  And that is something that makes consideration of what exactly goes on in places where there is government-run health care worth at least a little consideration, as this debate moves forward.

To be sure, there are good stories about the NHS.  Some of them, I'm confident, involve friends of mine who are doctors and other professionals who work within the NHS.  But there are also a lot of very, very bad stories out there-- and while I have total respect for the work that dedicated NHS staff, including some friends, do, I also think it's important to highlight these because they point to what is, in my view, a very flawed system and one that Americans should take pains not to replicate, or even get close to replicating.  So, from here on out, while the health care debate is ongoing in Congress, I intend to post excerpts of/link to items detailing ways in which the NHS is not so great.  Call it an ongoing NHS reality-check, if you will.

My point here, to be clear, is not to argue for maintaining the status quo with regard to American health care: Our system has flaws, too (too-high levels of the uninsured, underinsurance, generally, high costs of care and insurance).  But in my own experience, we also have better quality of care and treatment-- something that we should be very hesitant about sacrificing.  The focus in pursuing health care reform should, in my view, be getting more people covered by private insurance (not offering up "public insurance options") by pursuing free market reforms and reducing costs of actual health care (which will have knock-on consequences for insurance costs)while ensuring that we maintain and, if possible, improve the overall quality of care offered-- the latter two objectives being things that, incidentally, I think pushing for more transparency with regard to treatment costs and outcomes could help with enormously.  Movement towards a health care system about which stories like this one, titled "Patients with suspected cancer forced to wait so NHS targets can be hit," get written is not, in my view, reform or progress.  Over to the Telegraph for more:[intro]

People arriving at Accident and Emergency departments with symptoms which could indicate the aggressive spread of the disease are waiting weeks for diagnosis and treatment while “routine” cases are prioritised.

Hospital managers told researchers that treating desperately sick patients more quickly would “reflect badly” on their performance against Government cancer targets which only cover those referred to specialists by GPs.

Doctors, patients groups and politicians were appalled by what one described as a “breathtaking admission” which confirmed their “very worst fears” about how far the NHS target culture has gone in distorting clinical priorities.

Although most people with suspected cancer are referred to hospitals by their GPs, more than 30,000 people diagnosed with the disease each year are first alerted to tumours by violent symptoms, such as seizures, vomiting and jaundice, which cause such alarm that patients go straight to their local A&E departments.

The report by the NHS Institute for Innovation and Improvement, an official health service agency which issues advice to hospital managers, says that many of these emergency patients waited six weeks or longer for basic tests.

[...]

Some A&E departments failed to recognise the risk of cancer in seriously ill patients. In cases where the disease was suspected, patients were sent home to wait six weeks or longer for diagnostic tests. Others waited weeks on wards before seeing a specialist or having scans, the report, which is endorsed by the Government’s cancer tsar, found.

[...]

Among those who have experienced the problem is Melissa Matthews was 28 when she went to the Accident and Emergency department of her local hospital.

For several days, she had been suffering abdominal pain which had left her feeling so uncomfortable that she was unable to eat. She told her family doctor, who advised her not to worry, unless she began vomiting, in which case she should go immediately to A&E.

When she began being sick, her partner took her to the casualty unit of Norfolk and Norwich Hospital. The couple mentioned concerns about bowel cancer, having recently watched a programme about its symptoms, but the doctor reassured her: “You are far too young to have bowel cancer; when the blood tests come back they will show that”.

The tests did not indicate a problem; Miss Matthews was sent home to Norwich and told she was probably suffering from irritable bowel syndrome.

But the pain and vomiting continued. A week later, when she was unable to even swallow water, she returned to A&E, and was admitted to a ward for five days, but sent home once more.

One week later, after she collapsed in agony at home, she was admitted to hospital again. This time, X-rays revealed a blockage. During an eight-hour operation, surgeons found a tumour so large they were forced to remove her womb and 36 inches of her bowel.

The blood tests which Miss Matthews had undergone in A&E, she later found out, were not a clear indicator of bowel cancer, or its absence after all.

Six months of chemotherapy followed Miss Matthews’ operation, after which she was given the all-clear. However, since then the cancer has returned. On Tuesday, Miss Matthews, now 30, will undergo a second operation to remove a tumour.

Where diseases like cancer are concerned, six-week delays are the kind of thing that have a real impact on patients' prospects for survival.  I've often heard advocates for NHS-style systems respond to my criticisms about basic problems within the system by saying that at least, the NHS provides access to a basic level of care, albeit not very good care, to everyone, whereas our system does not, or does not do that very well.  In this case, "not very good care" seems like a bit of an understatement, and one that underlines the very real problems with an NHS-style system, where legitimately life-and-death issues are concerned.  Why would anybody want to fix a system that many say is broken by replacing it with a system that, from stories like this, appears broken also? 

As I've said above, I understand that Obama isn't advocating for the institution of an American NHS, but the apparent Democratic plan manifestly would move the country closer to government-run health care.  People should have an understanding of the things that go wrong when government plays in the health care arena, with the NHS as arguably the worst-case example, as this debate moves forward if the debate is to be, frankly, a public and a well-informed one-- which it of course should be.

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