I know Barbara has asked that we confine our health care discussions to one thread but I believe this is a separate discussion that I hope you folks in the UK address. I have "ripped a comment from a blogger from the Thom Hartmann site http://thomhartmann.org/eve/forums/a/tpc/f...51/m/2661036782


This started out as a discussion about Michael Moore and it "morphed" into a discussion about healthcare and "Sicko" This is one conservative bloggers perception of healthcare in the UK:

[b]I totally disagree. Are we perfect? Perfection is impossible. If you want to see failure look at England. What you dislike is that health care costs money and treatment is often associated with sad stories. England is a classic example of publicly funded, universal, socialist state medicine. Their system is collapsing, their doctors leave and practice where they can make a good living, they are rationing care and their citizens are leaving the country for treatment when the line is too long for them to get treated. Break a leg, they see you right away. Need a pacemaker, wait your turn.[/b]

I would love to hear from some UK folks about this comment Personal experience would be most welcome:
Thank you and thank you Barbara

you've got to understand when reading stories in the press that the NHS is used as a stick for the british media to beat the government (of whatever party) with - it's not as bad as you'd think from reading our news stories... actually I think it's got a lot better over the last 10 years especially in terms of getting to see a consultant.

Thank you Jon As I have suggested in a separate thread Americans only hear from the HMO's Health Maintenance Organizations (you folks in the UK don't know about them and you are better off believe me)
and free market think tanks like the American Enterprise Institute who claim if the USA enacts a NHS type of system, all hell will break loose and we will be waiting months to have an ear infection treated.

The problem with the NHS is that whilst the treatment is free and generally good the care (especially for people whose general health isn't good) is often of a lower standard.
And once the medical intervention has been completed and the care is designated 'social', it isn't necessarily free!

Well Mr Boyd I have two questions and one of them is loaded!

1: What improvements are needed to make it better?

2: Would you trade your system for an American type system? (loaded question)

is that a point about care outside the NHS J boyd?

I know it's often a struggle for people, especially if they're living alone to be discharged after something that's set them back in their capabilities - there's problems with the social services in a lot of councils and there's often problems in the handover from the discharging hospital to the patients home social services dept... but that's not *just* a NHS problem, it's a problem with the wider health and social security system.

BTW There's pilot NHS care trusts which are supposed to help bridge that gap for people who don't need to be in a hospital but can't just go straight back to their former life.

The answer to question 2., as you'd expect, is 'no'; but in the UK context, it's the wrong question - and I suspect it may be the wrong question for the US as well.
The difficulty is in answering question 1 (which is the right question for the UK): part of the answer is that it is too politicised and bureaucratic. It also spends far too much money telling people how to be healthy when most people know anyway. The more tricky areas are how can rationing of healthcare be achieved fairly and consistently and how to adapt to changes in medical practice.
Rationing is inevitable without a massive increase in expenditure (and therefore taxation). I would support that but politically, I think it's impractical. Alternatively, a great deal more could be achieved if the pharmaceuticals industry was not a commercial market (i.e. if it was socially owned - though that would have to be on a global scale). The second approach would be to stop letting consultants within the NHS undertake private work in addition to their NHS work. And politically, that would be as difficult as 'internationally nationalising' the drugs companies.
The other issue is that the UK has not resolved the question of how to care for people who live longer in poor health - in that sense the NHS is a victim of its own success.
And the underlying problem is that the electorate increasingly doubts the ability of government to use money it surrenders in taxes effectively - so whilst they are prepared to pay for a better NHS, they don't think that higher taxes will deliver improvement.
The question for the US, I suspect, is whether an insurance based system can be made to work; that's a very different proposition, because the NHS is a product of a time when 'big government' and state delivery of services was acceptable in a way that it probably isn't now, thanks to the neo-liberal triumph of the 80s and 90s. I think that an insurance system could be made to work; however, it would still face the problems of rationing and how to care for those with longterm conditions. And of course, as is the case here, there are vested interests in ensuring that any public system falls short of the standards that are delivered privately.

In part, yes, and I think that the separation of the NHS from social services provision is at the root of the problem. In fact, I'd argue that you have to look at the whole system (encompassing the NHS and social services) in order to ensure people are properly cared for. The Conservatives drew an entirely artificial (and damaging) distinction between 'health care' and 'social care' (the former being free of charge, whilst the latter is means tested and often expensive) and that's one of the biggest challenges for government in the UK.
However, I also think that the change in the role of nurses has caused problems: increasingly, they have taken on work which in the past would have been undertaken by doctors. That's not a problem in itself, but it has left a gap in responsibility for things like cleanliness (both of patients and wards) and feeding people, that hasn't been adequately filled - which has been a contributory factor to things like the hospital borne infections crisis.

[/quote]
In part, yes, and I think that the separation of the NHS from social services provision is at the root of the problem. In fact, I'd argue that you have to look at the whole system (encompassing the NHS and social services) in order to ensure people are properly cared for. The Conservatives drew an entirely artificial (and damaging) distinction between 'health care' and 'social care' (the former being free of charge, whilst the latter is means tested and often expensive) and that's one of the biggest challenges for government in the UK.
However, I also think that the change in the role of nurses has caused problems: increasingly, they have taken on work which in the past would have been undertaken by doctors. That's not a problem in itself, but it has left a gap in responsibility for things like cleanliness (both of patients and wards) and feeding people, that hasn't been adequately filled - which has been a contributory factor to things like the hospital borne infections crisis.
[/quote]

In the US, we have a discipline called "Infection Control" and its usually monitored by specialized nurses or professionals called "Sanitarians" In the US we are seeing this antibiotic resistant Staph and Strep infections that are the result of over prescribed antibiotics. its nasty.
Feeding the patients and assessing the nutrition status is the responsibility of dietitians

We also have different types of nurses.

We have Physicians Assistants who are closest in MDs to rank (in terms of diagnosing and ability to prescribe and treat), I think, and then we have different types of nurses (I can never remember what they're called) including Nurse Practitioners (much like PAs), Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and Aides. And then there are specialists like Nurse Anesthetists.

Tasks are divvied up with aides being more of the bedpan-emptying sort, LPNs monitoring eating and peeing and such, and RNs tracking vitals and giving care advice.

"Superbug" infections seem to be portrayed in the media as an issue of sanitation. They are not, and while sanitation may have been an issue in a few hospitals, superbugs are not a symptom of widespread problems with hospital sanitation. The solution to them will not be matrons, but microbiology.

Edited to add: this inacurate portrayal may actually be a case of EAS.

Superbug" infections seem to be portrayed in the media as an issue of sanitation. They are not, and while sanitation may have been an issue in a few hospitals, superbugs are not a symptom of widespread problems with hospital sanitation. The solution to them will not be matrons, but microbiology.


Well right now, infection and proper sanitary practices are the best we have.

Good one, Joe. (But depressing as hell.)

I can't see any benefit in forcing consultants not to do private work (as they do at the moment - perhaps contrary to american perceptions)

you'd really end up with a two tier system then with the private sector creaming off the talent and the NHS left with the dregs... Nye Bevin wasn't able to stick it to the Doctors when founding the NHS and you certainly won't be able to stick it to them now, forcing new contracts on them would violate all sorts of employment law and euroregulation about freedom of trade. Regardless of political support it'd be impossible practically I'm afraid.

Yes we have various grades of nurses in the NHS - including nurse practicioners (I think we nicked the idea from the USA) who bandaged my toe last time I broke it... the hospital nutricion problems I've seen tend to be related to the edibility of the food arriving from hospital kitchens, it's probably fine as it leaves the kitchen just hardens on it's way out to the wards in the heated trolleys, the level of dehydration seems to correspond with distance from the kitchen.


MRSA I'm told is a worse problem in the USA - just that as stated above it's not a stick for beating the US government with the way it is in the NHS here. The other recurrent gripe is 'postcode prescription' which I understand is standard practice in the US - but also something that's either not worried about or not regarded as being a problem of the government.

BTW I wonder if it's gangs of creationist zealots going round editing evolution out of wikipedia... it's not regarded as a bad word in europe afaict - if fact car adverts often boast that the new model isn't just designed better - it's 'evolved'

Actually, the Health Protection Agency advises that poor hygiene can spread both MRSA and C-Difficile and conversely that good basic sanitation can reduce rates of infection; injudicious use of antibiotics may have been a factor in the emergence of the problem, and it certainly isn't just about hygiene in hospitals (quite a lot of infections originate in the community and especially in nursing homes).
It may be that science will eventually provide new treatments that will enable these diseases to be controlled, though given that evolution inevitably means that new strains will emerge, there is always likely to be a kind of unwinnable 'arms race' going on and simply waiting for new treatments will cost lives.
In the meantime, hospital hygiene (and it is fairly obvious that we have a major problem here) is the key to control.

I agree about the practical difficulties; the problem is that we have a two-tier system already. And the reality is that whilst they also carry out private work, NHS consultants have a vested interest in ensuring that the free service isn't as good as that which is privately available.
Put it this way, if WH Smiths or Waterstones ran your public library, and they were selling the latest 'Harry Potter' at a big profit for £15, how likely is it that the library would have sufficient copies of the same book available to borrow in the week it was published to meet the demand?



I think that the problem with nutrition is really with patients who need encouragement and/or physical assistance in eating. I've had excellent food in hospital on the (thankfully very few) occasions I've been in. But I've always been able to eat it without help, I've known that I needed to eat it and I've been hungry. The concern I have is for those who don't feel like eating or struggle to feed themselves, because I've seen uneaten food taken away from them where in the past I think a nurse would have sat down and encouraged them to eat it.

health care is free at point of whotsit and as a diabetic Alberr pays no prescription charges even if the medication is in no way associated with his diabetes.. although most things are.

but dentistry is atrociously expensive even if you manage to get registered with an NHS dentist. If you need anything more than a filling it is two hundred squid for that treatment. If a week later you break a tooth and need a crown you have to pay another two hundred squid.

You can get free dentistry if you are on certain 'benefits' but if you are just low paid or a pensioner you have to pay up

me and him both needed a new crown this year so that is 400squid in dental charges.

rant over.. carry on.

Actually, over here, we're told that over-prescribing of antibiotics is a major factor (which doesn't stop doctors prescribing them for viral infections like colds, without testing to see if a bacterial infection is even present ).

We're also strongly advised to avoid using anti-bacterial soaps and cleansers in the home, as it's believed they can contribute to the growth of "superbugs". The public health message is that ordinary, garden-variety soaps are every bit as effective as the anti-bacterial stuff.

Holy crap! That's insane. I really, *really* don't understand why dentistry is considered separate from other medical stuff--a bad dental situation can rapidly lead to really bad general health stuff. I am, as of September, without dental insurance for the first time in my adult life. I have really good teeth (no fillings!), but it really stresses me out just at the thought that I might take a hoof to the mouth or something and need dental care.

*brushes*

strangely enough
The libraries round here aren't run by Waterstones - but they still didn't buy in enough copies of Harry Potter for everybody to have one at once.

Perhaps it wasn't the right analogy.
Mind you, look out for your 'Head of Library Services' suddenly leaving to become a director at Waterstones.

In answer to your request for info, Jamesleo...

The blogger hasn't a clue. He or she is trotting out the (US vested interests) message that the US system is better. Note the use of the word "social". They can't quite bring themselves to say "commie" because they would, quite rightly, be shown up as the complete fuckwits they are. Social is being used as a slur, as if the satet doing anything for the citizen must by definition be bad.

I lived for 50 years in the UK and never paid a penny for any medical treatment - apart from dentistry, which is why my teeth are shite and the subject has been covered earlier in this thread - not a penny aside from prescriptions which at the last count were capped at summat like 6 quid a throw.

I've been here in the US for less than two years and I've already spent more on seeing docteors than in the previous 50. And apart from some painkilling/anti inflamatory tablets I've received no treatment yet.

I'm not going to be insulting any Americans on this forum when I say this. They know the truth and it's painful and embarrassing and they know that it's unconscionable that it continues as it does but the US health care system is complete wank.

Whereas the UK healthcare system is constantly sniped at by dimwits and numpties yet is one of the finest in the world.

Walking the dog today I was mulling over how bad my knee and generla health has got to get before I say to Maria that either we move back to teh UK as a family or I go alone.

There I've said it and I've put it in "print"

My employer is doing it's very best to kill me with work.
The healthcare system just wants my money and couldn't care less if I get well or not.

This country could be so the BEST country in the world. But they won't have the revolution they need.
They fucked the British off no problem. It's about time they fucked off the corporations and the neo cons.
Oh and the fucking psycho Christian Zionists, the rapture evangelicals, and the diehard macho flag-waving thugs who believe America is done for unless “Islamofacists” are exterminated. (thanks to Paul Craig Roberts)


But I digress, slightly.

My father has received treatment over the last ten years that would have cost him or his insurance company anything from 75 to 200 thousand dollars. He hasn't paid a bean apart from his national health deductions from his salary over a working lifetime. Add to that the treatment my mum has received and the care that the NHS took of me and my brother from the cradle until the day we left the UK plus the care it took and still does, of my son and daughter still in the UK the cost must be in the millions. That's just for one family.
But while the state was taking a little and giving a lot my family was able to live, love, play and work and be useful members of society without ever, EVER, having to give even a moments thought to what might happen if we got sick or had a nasty accident.

The US, particularly this Pacific North West, is a huge wide open space with glorious scenery, unspoilt wilderness that stretches for hundreds of miles, virtually (from my perspective) traffic free highways and yet I've spent more time worrying about health care (selfishly, I admit, my own) than is ...well.. healthy.

Things had better start getting better soon. And I don't just mean for me because this way of living, no matter how much they try to convince themselves otherwise with their cell phones and 52 inch LCD TVs is not civilised.

Don't you have your lovely wife's blessing (and assurance that you'll manage without that income) to quit?

Of course he does.

Martyn forgets to breathe sometimes.

Oh, and our library had over 100 copies of the latest Harry Potter available. Just saying.

Whatever American perceptions of the NHS might be they must assuredly be wrong about GB as a whole.

Maria concedes quite willingly that the NHS is to be envied, especially by Americans, but who - and I cannot for the life of me come up with a decent answer - would want to live in a country where this happens all too often?

Three teenagers have been jailed for life for murdering father-of-three Garry Newlove, who was kicked to death outside his Warrington home.

Here I am whining like a baby about the poor healthcare system and back home blokes are getting kicked to death by drunken teenagers.

(and OMG! One of them was out on bail after being detained for assault. Nice guy)


No where's perfect. But I can only agree with Maria when she says that Ara stands a better chance of a decent life here than in a place that seems determined to cling to the idea that getting shit faced of a Friday night (and Saturday too if pos and even better if there's a bit of a fracas with the fuzz for afters) is an acceptable form of recreation.

Chatting to a fellow BBF member this evening I was rather astonished to learn that a wave of apathy has engulfed the UK. Was it like that when I was there less than two years ago? I don't remember thinking so.

Anyway, I'm breathing again now. I have regained, in the intervening 24 hours, some perspective and look forward to a visit to the UK in the not too distant future, from which I will return.

Won't bother to get my teeth done while I'm there though, cus the service is crap

Of course Martyn is absolutely right. I heard on Saturday night that a bunch of drunken teens were bricking pensioners bungalows yards from where I live. In all honesty I dread the summer coming, hoards of scum hanging outside the shop and council estate opposite to where I live. Still, the alternative is standing up to them and thus booking yourself in to your local hospital as a result and testing out the British NHS first hand.

(Hopefully the last sentence means I didn't digress completely).