The Dark Side of Britain's Health Service
GELB, NORMAN
Covert Rationing The Dark Side of Britain's Health Service By Norman Gelb London Britain's National Health Service (NHS), apioneering effort to provide free medical care for all...
...Meanwhile, the NHS has been the victim of serious miscalculations...
...Hence the question being asked is: Would the expansion of social services do more to cope with a community's health problems than allocating more money for its medical care...
...So is Health Secretary Alan Milburn's ruling that day-to-day NHS operations should be overseen by doctors, nurses and hospital executives, not the civil servants who have been burdening overworked hospitals with paperwork...
...But the present distinct gap between promise and reality has prompted approximately 11 per cent of the population to supplement NHS coverage with private health insurance...
...Like doctors, many nurses who are admirably trained by the NHS leave for better jobs abroad...
...In emergencies, though, they are advised to rush, by NHS ambulance if necessary, to the Accident and Emergency (A&E) departments of their local hospitals...
...A patient might therefore have an operation performed in a private hospital by the same surgeon who would have performed it at an NHS hospital if he or she were prepared to join the waiting list...
...Indeed, it is widely agreed that if immediate treatment were available, an NHS hospital would be fine...
...Suggestions that individuals be required to contribute toward their care—besides what they pay for medicines—are made with trepidation...
...This has created a demand for additional funds to provide the services, raising the concern that the NHS will ultimately be the financial loser...
...After a surgeon has done his work and left, the patient could be in trouble if a postoperative emergency develops...
...The public must understand that health care rationing is inevitable," it argues...
...The Society of British Neurological Surgeons says apaucity of brain surgeons risks reducing Britain to a second- or third-rate country in the treatment of neurological ailments...
...The crucial difference is that the doctor seen privately will be there at the appointed time, the operating room will be ready, and a bed (commonly in a private room) will be at the patient's disposal...
...WHEN THEY sign up for the NHS, Britons choose a neighborhood general practitioner (GP) they are supposed to consult if medical attention is required...
...In the light of the growing level of demand for up-to-date medical care, and of the inescapable limits on funding, perhaps nothing more than what it is delivering can be expected of the National Health Service...
...Most of the country's A&E departments are to be modernized...
...One of Labor's early moves when it came to power was the cancellation of this tax benefit...
...The object is to revitalize the National Health Service and again make it the paradigm other nations pursue...
...Several of the NHS' core problems are attributable to progress...
...Having to deal with an aging population was not sufficiently factored into the equation...
...And an ambitious 10-year program to deal with heart disease is in the works, as are programs for training more specialists and nurses...
...Those people generally continue to use the NHS for routine health care—a flu shot, a cough diagnosis, pain killers, sleeping pills...
...According to the World Health Organization, the lack of adequate resources is responsible for the deaths of 25,000 British cancer patients every year...
...A 50-year-old uninsured Englishman sent the government a bill for almost $19,000 after a heart operation he felt compelled to have done privately...
...everything is funded by the government...
...The National Institute of Clinical Excellence should publish guidelines on which treatments should be given to whom, and in what circumstances...
...A recent study showed that affluent Arundel in West Sussex is the healthiest town in the country, requiring proportionally fewer medical staff, hospital beds and medicines than, say, predominantly working-class Salford and central Manchester in Northern England or the less affluent corners of London...
...With good reason...
...He say s he would not have survived had he joined a 14-month NHS waiting list for it...
...By contrast, a woman who visited New York during the winter and contracted pneumonia was required to stagger through the city's frigid streets to get medical care...
...The people who bought it were offered significant tax credits, bringing their premiums down...
...Even if that is the reality, it would be a mistake not to keep in mind Tony Blair's probably pretty accurate observation: "The vast majority get good NHS treatment...
...Miscalculated, too, was the impact that meeting crisis after crisis would have on underpaid nurses...
...But difficulties arise at the very beginning of the process...
...The cost of pharmaceuticals has skyrocketed so relentlessly, however, that others must now pay $9.50 each time they fill a prescription...
...They see their family doctors for everything from antibiotics to referrals to specialists, who treat them free of charge...
...One elderly man died 200 miles from his home after being ferried by ambulance for five hours in search of a bed...
...Officials are reluctant to reveal publicly what medicines are not available where, but many sufferers are agonizingly aware of being denied new, improved ones that they cannot afford to buy privately...
...In some hospitals patients were actually treated on gurneys...
...The advent of improved medical procedures, such as keyhole surgery, convinced NHS managers that patients would require briefer hospitalizations...
...A Newcastle woman suffering from a potentially fatal liver disease has been advised to move to Scotland, where the one drug she has been told could help is more readily available "on the NHS...
...There is concern about patient care at private hospitals...
...Though practically all British doctors are employed by the NHS, specialists often divide their day between the NHS and a lucrative private practice...
...They are perceived as mere first aid...
...such a precedent would bankrupt the government...
...Others shift to less stressful jobs in small private British hospitals...
...These doctors know that more than 1 million people in Britain have been awaiting NHS hospital care for over a year, and that a significant number suffer from worsening cardiac conditions and cancers that will kill them before they can be treated...
...In its desperate quest for more hospital beds and medical staff, though, the Labor government has lately found itself obliged to let the NHS tap into private medicine's resources...
...On the contrary, most have joined the media's relentless criticism and condemnation of the system...
...When she returned to London, her own GP told her that for cost reasons he could not have done the same...
...A covert triage system for kidney patients often automatically favors young people requiring daily dialysis over elderly sufferers...
...They are still free for children, women over 60, men over 65, and anyone receiving state income support benefits...
...During the same period a patient had to wait 16 hours on a gurney at London's Charing Cross Hospital before being treated for facial injuries...
...Without exception, the doctors she telephoned thought her asking them to make a house call was downright preposterous...
...The development of new medicines and medical equipment is similarly a big strain on budgets...
...There are millions of people every year in Britain getting superb health care from the NHS," he points out...
...Furthermore, an increasing number of British doctors, particularly specialists, have been tempted by better remuneration and working conditions to emigrate to the United States, Canada and Australia...
...Norman Gelb reports regularly for The New Leader on British affairs...
...Only 3 per cent of multiple sclerosis patients, for example, are being given beta interferon drugs their doctors know they should have...
...The quality of the surgery, in other words, is likely to be the same at both facilities...
...He is not altogether wrong...
...Covert Rationing The Dark Side of Britain's Health Service By Norman Gelb London Britain's National Health Service (NHS), apioneering effort to provide free medical care for all citizens launched in 1948 by Prime Minister Clement R. Attlee, was once the envy of other countries...
...No wonder the Conservatives are wary of pressing too hard for privatization, their all-purpose solution where government funds are involved...
...Thus some expensive medicines are prescribed in one part of the country and not in another...
...Another seriously ill patient was shunted by helicopter hundreds of miles before one was found in the Scilly Isles off the coast of Cornwall...
...Responding to the public's outcry, and trying to fulfill its own promises in a Patients' Charter it issued upon coming to power in 1997, the Blair government recently initiated major NHS reforms...
...He is unlikely to collect...
...A second miscalculation has produced a desperate shortage of hospital beds...
...Prime Minister Tony Blair calls the media criticism "alarmist nonsense...
...At the same time, the government underestimated how many doctors would take early retirement at 60 rather than endure the pressures of working in the NHS, especially since they were guaranteed good pensions to do so...
...But that is far from guaranteed, whereas private insurance does offer attention within hours when essential, and otherwise within a few weeks or even days...
...That is no meager achievement...
...Since people are living longer, they require more years of medical attention...
...Yet the insurance is not quite the panacea it might seem...
...Despite its shortcomings, the NHS is as firmly ingrained in Britain as Social Security is in the United States...
...The situation has been exacerbated by an unexpected decline in the flow of doctors from the Commonwealth nations, notably India, Pakistan and Sri Lanka, once a reliable source of well-trained medical personnel...
...It now reluctantly pays private hospitals substantial sums for use of their spare bed space by NHS members and doctors...
...State-of-the-art equipment to diagnose and treat cancer is being funded...
...It is not only beds that are in short supply...
...New hospitals are under construction and others are in the planning stage...
...The local GP she went to as someone covered by the NHS prescribed a particularly effective new drug...
...Today it is subject to almost daily newspaper and television reports of inefficiency, incompetence and even tragedy...
...But most distracting for those who draw them up is the growing agreement that improved social services in deprived areas reduce health problems...
...Whole wards were irrevocably closed...
...The three Englishmen I know who have had cardiac problems received bypass operations without inordinate delay, and feel they received commendable postoperative care...
...There are not enough doctors in Britain because it was decided some years ago to cut back the number of medical students...
...Originally, medications prescribed by GPs and at NHS hospitals were provided without charge...
...The fact that those paying premiums enjoy a significant advantage when they fall ill is a nagging affront to Labor Party principles...
...The regional NHS authorities, moreover, are under varying budgetary constraints...
...Some of those operations were canceled after the patients were prepared for surgery...
...The 89 per cent of Britons who don't have the added coverage are not happy either...
...Unless already mortally ill, insured persons do not die while waiting to be treated...
...One 74-year-old woman in Leeds had her cancer procedure rescheduled four times, then was informed that the disease had spread and was inoperable...
...They know that better than 50,000 scheduled operations were canceled last year because acute medical emergencies had to be given priority, or because necessary drugs or specialized equipment were not available due to budget constraints...
...The public," the fand maintains, would then at least "know what they can expect from the NHS and what they will have to pay for themselves...
...There are far fewer heart surgeons than needed...
...Complaints have been made about the absence of proper regulation of their health care standards and inadequate medical supervision...
...At one stage during the flu epidemic early this year, the NHS discovered that not a single intensive care bed was available in southeast England where one in seven Britons lives...
...And a shortage of prosthetics as well as qualified staff is forcing nearly half of all NHS hospitals to cancel hip replacement operations...
...It is also not uncommon for seriously ill individuals to receive home visits from doctors...
...Few doctors or NHS managers are prepared to speak reassuringly about the level of British health care...
...The highly respected King's Fund, an independent health care charity, urges recognizing that there will never be enough money pumped into the ever-demanding system...
...Should specialized equipment or drugs become required, he may actually have to be rushed by ambulance to the nearest NHS hospital—and displace someone on a waiting list...
...Overburdened GPs allow an average of six minutes for each patient's visit...
...It is estimated that one in 10 hospital beds is currently occupied by a person needing extended care...
...But everyone agrees more has to be done than the announced budgetary injections, construction plans and procedural reforms...
...Though doctors come in as scheduled to treat their patients, few private hospitals have a qualified medical staff in residence around the clock, and some have little in the way of advanced medical equipment...
...No money ever changes hands...
...A woman vacationing in Norfolk was fortunate to have contracted shingles where she did...
...Millions here do receive good to excellent medical attention without having to pay a penny...
...Yet reasonable as that may sound, it would amount to official approval of a system in which full coverage is restricted to people able to supplement what the NHS covers...
...But crisis management, prioritization and crutch support from the profit-making private sector look like they will remain features of comprehensive health care here—a bright vision that most consider their birthright, however dimmed...
...Under recent Conservative governments, private health insurance was encouraged as a means of taking some of the load off the NHS...
...Consequently, even individuals who genuinely need immediate attention frequently have to wait five hours or more in an A&E department for treatment...
...Many people believe they can get better care at hospitals, so an increasing number are heading there directly...
Vol. 83 • July 2000 • No. 3
