posted by ![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
smallfuzzy at 09:40pm on 17/08/2009
smallfuzzy at 09:40pm on 17/08/2009Right. As my other, off-the-cuff post created a good deal more discussion than I expected, I'm going to sit down and talk properly about the NHS and try to put some information out to counter the misinformation that seems to be bouncing around the other side of the water.
My Stake In This
Here is the honest truth. Unless you guys are dragging us into wars the Brits don't actually care all that much about what is going on US side. Seriously, we kinda expect you to be crazy, and the most you're going to get out of us most days is an eyeroll and "oh, those crazy Americans."
Until your stuff starts insulting our stuff. Then it's personal.
It's your country. I'm sure you'll vote for whatever you want for it. But I feel the same way about "the Brits put their old and really sick people before a death panel who decide if they would live or die! Stephen Hawking would never have been allowed to live there!"* as if one of our mainstream political parties started running ads that shouted "DON'T VOTE FOR THOSE GUYS, IN AMERICA THEY ENSURE THAT THE POOR PEOPLE ARE COOKED INTO PIES!" Imagine if they did that, and we seriously believed it, and how we'd start thinking of you awful people-pie eating Americans. Not nice, is it?
There's good stuff in the NHS, and there's bad stuff. I'd rather that at least the bad stuff you knew about was the bad stuff that was actually true, rather than that you guys were wandering around going "Oh, Laura's grandmother's really old. Poor Laura. I bet they shoot her next time she's sick."
The plural of anecdote as we all know, is not data. But I can at least chat about some of my experiences with the NHS. I'm sure other Brits can chip in with theirs (Hell, US guys, chip in, tell us how this stuff works your side of the water). And possibly we can build a picture of what is expected and normal over here as opposed to over there, and get something a bit more accurate and realistic into people's heads. Edjumucation is good!
* He's British. And not dead. Seriously, guys, what the hell?
Dental Work
Why not start with something we all know to be bad - the British teeth!
British teeth are known to be bad -- in fact, we think perfectly white straight teeth are perfectly creepy. I'm gonna step up here and admit I am a fully paid up member of the Bad British Teeth Society -- in fact I would take a photo to prove it if I could be bothered to get up. They're slightly yellowing, and crooked as all hell -- though I should point out that they are still all my own and I am filling-less.
Why is this? Britain views orthodentistry pretty much in the same light as cosmetic surgery. Not only does the NHS not cover it, but I'm pretty much most dental plans here don't either. Unless you have serious will-not-be-able-to-eat issues, or are rich (and I mean rich here, lower middle class probably isn't going to cut it) you better hope they grow in straight.
On the other hand for stuff that isn't counted as cosmetic, costs are either free or supplemented with NHS dentists. If you're unemployed, on certain benefits, a pensioner or under 18, and you need a check-up, a filling, a tooth removing, hell, even a visit to the dental hygienist it will be completely free. If you're working, there will be costs, but those costs will be standardised. Details are here but basically you'll never pay more than £198, even if your entire mouth needs replacing and it's an emergency surgery, with an NHS dentist. Most stuff is less -- for instance, I pay £16.50 for a check-up and dental hygienist visit.
On the other hand it can be quite hard to find an NHS dentist with places at present. Unfortunately, the NHS doesn't have enough signed up right now, which is resulting in a lot of folk going private, and some doing, as I do, and driving miles to visit their dentist as there isn't one available to switch to.
It's not perfect. However, it is worth noting that if you need emergency care -- IE, if you roll out of bed tomorrow with raging toothache -- you'll get it, that day, even if you're not registered with an NHS dentist. Unlike the US, this doesn't involve a hospital visit. You call NHS Direct, and they help you out from there.
NHS Direct
As I've mentioned it, I may as well go on to NHS Direct.
NHS Direct is a helpline originally conceived by the bean-pushers to cut the queues in doctor's surgeries. It was meant to be for those things where you either weren't sure whether a doctor visit was needed (hands up who doesn't want to go to a doctor just to be told to rest and drink fluids?) or where it was out of hours and you didn't know if you were bad enough to need hospital. They also give help if, for instance, you need an emergency NHS dentist, or the nearest out-of-hours pharmacy, or the nearest walk-in clinic.
Basically, you call. You get through to an advisor, who lets you either ask your question or takes your symptoms. Then.. it used to be that a nurse would call you back, but the last time I used them it was my nearest on call doctor. Has policy on this changed? Does anyone know?
NHS Direct are struggling at present due to swine flu (or they were until the swine flu helpline launched -- anyone got an update?) and I have heard a lot of misdiagnosis stories about people's sister's niece's daughters having meningitis which was totally missed. However, I can't honestly say I know anyone personally who has had problems, and while callback times can be lengthy, they've always given me good advice when I got through. On one occasion, with appendicitis, it was NHS Direct staff who urged me to go to the doctor as soon as the clinic opened and probably saved my life (I thought it was just a REALLY BAD virus or food poisoning). In another, a couple of weeks ago, when my chest seized up after the flu, a doctor called me back and chatted to me, checked my symptoms, and told me what symptoms I should watch for because I'd need immediate medical attention (After a week of flu not being so bad, my chest suddenly went very tight which was just plain scary. I couldn't remember how bad it SHOULD be before not breathing was something I needed to worry about).
Opticians
Okay. Raise your hands. Which UKers were victims of the horrible beast known as.. NHS glasses.
*raises own hand*
When I was a kid, all under 18s got free glasses as needed. Which was awesome. Except that, if your parents couldn't afford a bit extra for the frames, they were ugly as hell and you were marked for life with your awful, awful jam-jar specs.
At some point though, the opticians wised up. They realised that most kids didn't have eyes of MAGICAL FIXINGNESS and in most cases they were gonna need glasses or contact lenses for life. This meant that it was better for them if, as soon as they hit the age of majority, the kid didn't rip the glasses off and swear to be happily blind forevermore. Nowadays, no matter how poor their parents are, most kids can get glasses in actually quite pretty frames. Again, the unemployed, pensioners, and those on certain benefits can also get free specs.
If you're working, however, it gets a bit more complicated.
If you're in a job which doesn't involve a computer screen, and you're on no benefits, and you aren't actually one step from blind, you're out of luck. You're buying your own glasses or contacts.
If you're in a job which involves display screen equipment, your employer is obliged to foot the bill for you attending an eyetest once every two years. If that eyetest comes back with you needing glasses for display screen equipment your employer is then obliged to supply you with a voucher. You can then hotfoot it away and get your glasses or contacts up to the value of that voucher. If the ones you like are too much, you are allowed to top up the amount.
Note the careful wording there though. While my last (slightly crooked) optician was happy to sign that I needed a voucher, my current (much better) optician will gently point out that without glasses I would have problems finding the sign. No voucher for me. If my left eye was slightly worse I would receive NHS help with glasses funding. As it is, I pay for them myself. LIFE IS SO HARD.
In all seriousness, I would be fully behind more even provision for eyecare, just because I share a road with these people. I don't particularly want to be driving in front of Jimmy, who hasn't been for an eyetest in four years because he's scared he can't afford the new glasses, you know?
Day to day care
In all honesty, if you asked me five years ago about getting a doctor's appointment I would have gone into a pissy rant about how you could never get one out of working hours, and you had to wait five days for an appointment because they liked you to be good and sick.
Two years ago, you'd have got another pissy rant. We had walk-in centres where you could go and wait to be seen if you lived in a city, but out of cities was another matter. I distinctly remember one receptionist making me cry. I called up post-appendicitis, because my stomach was hurting which I had been told was a potential sign of infection (very bad -- can kill you). I was working 12-8, in a new job where even taking time for a doctor's appointment while on probation would result in me losing it. I could not afford to lose my job. I explained, I begged for an emergency morning appointment, and she told me that if it was a real emergency I wouldn't be at work. (I believe mum later made an official complaint).
Now though. Now is a different matter.
There are walk-in centres now, operating seven days a week, even out of the city centres. I mean Teesside has one, for God's sake -- it's hard to find, but it's there. You can ALWAYS go wait there for an appointment. My regular doctor opens late Monday evenings so that working folk don't have to skip work. And while you might have to wait a while to get through if you call when the doctor opens, they can almost always get you a same day appointment, and they will try to work with you to find a good time for you.
I cannot overstate how awesome this is when you're coughing your guts up, or clutching a throbbing ear, and can't afford to leave work at lunchtime, drive home and then drive back. It is awesome. Also, free.
Perscription charges
If you are under 18, on certain benefits, or a pensioner, your perscriptions will all be entirely free. Painkillers, antibiotics, whatever -- doesn't matter. They go, get their meds, come home. Free.
Otherwise, you pay £7.20 per perscription. Doesn't matter what for. If you're going to need a lot, you can pay £28.25 which will cover your charges for the next three months, or £104 covers you for a year.
Birth control is always free. Some illnesses -- I know thyroid is one of them -- you will receive your drugs for free. I was told that this is because these illnesses do not immediately kill you if you don't get your drugs, so people who are struggling may be tempted to put off getting their next lot in order to make bills. I'm all in favour of people not dying, although it can sometimes seem a bit hit and miss as to what falls into this category.
Emergency care
This is where it matters. And where it matters, the NHS is there.
I've mentioned the appendicitis a few times. Two years ago, I started having cramps that felt a whole lot like period cramps. As I do for such cramps, I took ibuprofen and ignored them. When I started feeling REALLY bad a few days later, I blamed indigestion. Then food poisoning. Then a virus. Finally, at 6AM in the morning, after throwing up every 15 minutes through the night, I called NHS Direct.
They directed me to the doctor. If I had been alone in the house -- my mum was there -- I believe they would have sent an ambulance. The doctor sent me to hospital. Again, if I hadn't had my mum there to drive me, transportation would have been provided.
There was no waiting in the A & E room at the hospital. The doctor had called ahead, and I was wheeled straight through to a bed. No form-filling, you'll note, except for the "Please rate pain on 1 -10" and "Are you pregnant?" I was given a morphine shot. I was sent for scans that day. And the next day, I was sent for my appendix to be removed.
It turned out it had already ruptured, leading to peritonitis. I was kept in hospital for five days -- they nearly sent me home on the fourth, but decided my bloodpressure was too low. Cost was not an issue. Knowing I was safe to leave was.
I was provided with about four different antibiotics and painkillers (it turns out codeine hates me, but that's a different story). A few weeks later, when I overdid it, and it started hurting, and we were scared of infection, I was sent back. Again, scans were done, I was kept in overnight and then sent home.
All of this, other than the meds, were free. I paid £7.20 for each of the packets of pills.
When I passed out at work, scaring my boss half to death, and the doctor picked up a heart murmur, I was referred right-quick to hospital for checks. Similarly, when the baby sister applied to join a gym and they picked up tachycardia (heart beats too fast), that was a very quick send-on.
Lest you think that my life was spared due to not being old and due for a death panel, the NHS also got my grandfather through several strokes -- and they were patient with him even when one made him so confused and panicked he took a swing at one of them (and even at 70-odd, my grandad was a big strong man). My great uncle had his first heart attack the year of my birth. He had a pacemaker fitted. He died, after several more heart attacks in his life time, when I was 21.
Pallative care
This is where it would be easy to cut care, which is why I twitch again at the whole "death panels" idea.
Look, as some of you guys know, my cousin had a car accident when I was tiny and he was 17. It was a bad one. There was severe brain damage. The option to turn off the machines was given then, and several times over the years that followed at times when he became worse. It was never taken (whether it should have been is a discussion for another day) and even though there was no option of my cousin ever recovering much, no pressure was put on my aunt by the NHS to make that choice.
The NHS provided help (although there was a compensation pay-out which also helped) to get their home converted so he could live there. It was instrumental in this, and that was the difference between my cousin living his last days permanantly in a hospital bed, and his last few years at home with family coming and going around him.
After he died, my grandfather (not the one who had the strokes) had his own health issues with asbestosis. If you don't know what this is, it's a horrible illness which comes from exposure to asbestos -- particularly horrible if you don't have free healthcare because most of the people who have had this exposure are likely to be blue-collar guys without much cash. It is incurable. Again, the NHS provided oxygen and help to keep him at home until he absolutely had to go to hospital at the end.
I'm not saying that it couldn't be improved. There's a lot I'd like to improve here, including lifting carer's payments to an actual amount it's possible to survive on. But the NHS certainly didn't give up on them.
Referring to Consultants
And now after praising them mightily, I must damn them mightily too, because this is where they can fail -- in that gap BETWEEN "someone is dying and needs immediate care" and "this person needs antibiotics". If you have something that needs more than a GP and less than an urgent hospital visit.. yes. That can be rough. I hear that you folk in the US get gyno visits if you're on the pill any length of time? We don't. And yes, there are waiting lists, and it can take an age, and... they're trying to get better. But it's still pretty bad in this area.
They have the same problem with mental health care. You must be referred for mental health care. For several years now, I've been struggling with winter anxiety and depression -- possible SAD. When it gets to its worst, I go to my GP and ask to be referred. Sometime later, in mid-summer, I get a phonecall to schedule an appointment. THREE GUESSES WHY THIS DOES NOT HELP.
Preventative Care
Woo, hit and miss! Americans don't necessarily have MORE jabs than we do, but I believe we have different ones -- we don't get flu, but I believe you don't get meningitis ones? (UKERS! POP QUIZ! SYMPTOMS OF MENINGITIS AND NO PEEKING AT THE COMMENTS TO CHEAT!) Actually, I've never heard a US-side person talk about meningitis much which throws me -- is it not an issue there? We had a kid in my year with it when I was at school.
The jabs we do have are getting better now, but we had a few years of sketchiness. The baby sister (who is actually 21, for purposes of clarity) and I fall in a group which only got half our MMR jabs for some weird reason, which means we're still a risk for measles, and at one point were quarantined for potential mumps. Also, we both had chickenpox (in my case, the day after a wedding. I'm just awesome like that) They're now vaccinating all 14 year olds against cervical cancer, and checking those over 25 for it, but, uh, if you fall in that hole between the two you're doomed?
On the other hand, a few months ago we sent a roadshow around the UK to check the heart of anyone under... 30, was it? for anomolies, as heart failure in the young can hit suddenly and without warning. And, as I pointed out in the other post, the joy of illness is that it doesn't appear with girt big I AM SERIOUS signs. A lot of heart attacks -- especially in women -- are missed because a mild one can pass and they don't want to make a fuss over what was maybe nothing. As the second one can then kill you, I'm all for getting that maybe-nothing checked out for free.
Experimental Methods
I'm going to stop soon, because my arm is starting to hurt.
Someone highlighted in the previous posts that the NHS will sometimes block expensive and experimental medicines. Which, yes. Is true. That doesn't meant that we never take a chance. or that we can't be awesome.
Sometimes, it's just that a drug is too expensive and has too low a success rate to be available. The person does then have the option of going privately, or sometimes arguing with the NHS can lobby them to change their mind. It has happened before. It should be noted that people too poor to get these drugs privately in the UK might also be too poor to afford the insurance that would cover that particular drug in the US also.
I would like to see changes in this area however. I would like to switch to a method where, in these circumstances, someone could "topup" NHS care with payments of their own, instead of the current stark choice, under these circumstances of "PUBLIC OR PRIVATE, THERE IS NO IN-BETWEEN."
Or, you know, we could set up all drug companies as nonprofits so the drugs aren't so expensive in the first place. But I can't see that one happening somehow. ;-)
My arm hurts now, so I'm stopping. But I will finish with these figures from the Beeb on life expectancy, expenditure and infant mortality. They make interesting reading.
Questions? Anecdata? Arguments?
My Stake In This
Here is the honest truth. Unless you guys are dragging us into wars the Brits don't actually care all that much about what is going on US side. Seriously, we kinda expect you to be crazy, and the most you're going to get out of us most days is an eyeroll and "oh, those crazy Americans."
Until your stuff starts insulting our stuff. Then it's personal.
It's your country. I'm sure you'll vote for whatever you want for it. But I feel the same way about "the Brits put their old and really sick people before a death panel who decide if they would live or die! Stephen Hawking would never have been allowed to live there!"* as if one of our mainstream political parties started running ads that shouted "DON'T VOTE FOR THOSE GUYS, IN AMERICA THEY ENSURE THAT THE POOR PEOPLE ARE COOKED INTO PIES!" Imagine if they did that, and we seriously believed it, and how we'd start thinking of you awful people-pie eating Americans. Not nice, is it?
There's good stuff in the NHS, and there's bad stuff. I'd rather that at least the bad stuff you knew about was the bad stuff that was actually true, rather than that you guys were wandering around going "Oh, Laura's grandmother's really old. Poor Laura. I bet they shoot her next time she's sick."
The plural of anecdote as we all know, is not data. But I can at least chat about some of my experiences with the NHS. I'm sure other Brits can chip in with theirs (Hell, US guys, chip in, tell us how this stuff works your side of the water). And possibly we can build a picture of what is expected and normal over here as opposed to over there, and get something a bit more accurate and realistic into people's heads. Edjumucation is good!
* He's British. And not dead. Seriously, guys, what the hell?
Dental Work
Why not start with something we all know to be bad - the British teeth!
British teeth are known to be bad -- in fact, we think perfectly white straight teeth are perfectly creepy. I'm gonna step up here and admit I am a fully paid up member of the Bad British Teeth Society -- in fact I would take a photo to prove it if I could be bothered to get up. They're slightly yellowing, and crooked as all hell -- though I should point out that they are still all my own and I am filling-less.
Why is this? Britain views orthodentistry pretty much in the same light as cosmetic surgery. Not only does the NHS not cover it, but I'm pretty much most dental plans here don't either. Unless you have serious will-not-be-able-to-eat issues, or are rich (and I mean rich here, lower middle class probably isn't going to cut it) you better hope they grow in straight.
On the other hand for stuff that isn't counted as cosmetic, costs are either free or supplemented with NHS dentists. If you're unemployed, on certain benefits, a pensioner or under 18, and you need a check-up, a filling, a tooth removing, hell, even a visit to the dental hygienist it will be completely free. If you're working, there will be costs, but those costs will be standardised. Details are here but basically you'll never pay more than £198, even if your entire mouth needs replacing and it's an emergency surgery, with an NHS dentist. Most stuff is less -- for instance, I pay £16.50 for a check-up and dental hygienist visit.
On the other hand it can be quite hard to find an NHS dentist with places at present. Unfortunately, the NHS doesn't have enough signed up right now, which is resulting in a lot of folk going private, and some doing, as I do, and driving miles to visit their dentist as there isn't one available to switch to.
It's not perfect. However, it is worth noting that if you need emergency care -- IE, if you roll out of bed tomorrow with raging toothache -- you'll get it, that day, even if you're not registered with an NHS dentist. Unlike the US, this doesn't involve a hospital visit. You call NHS Direct, and they help you out from there.
NHS Direct
As I've mentioned it, I may as well go on to NHS Direct.
NHS Direct is a helpline originally conceived by the bean-pushers to cut the queues in doctor's surgeries. It was meant to be for those things where you either weren't sure whether a doctor visit was needed (hands up who doesn't want to go to a doctor just to be told to rest and drink fluids?) or where it was out of hours and you didn't know if you were bad enough to need hospital. They also give help if, for instance, you need an emergency NHS dentist, or the nearest out-of-hours pharmacy, or the nearest walk-in clinic.
Basically, you call. You get through to an advisor, who lets you either ask your question or takes your symptoms. Then.. it used to be that a nurse would call you back, but the last time I used them it was my nearest on call doctor. Has policy on this changed? Does anyone know?
NHS Direct are struggling at present due to swine flu (or they were until the swine flu helpline launched -- anyone got an update?) and I have heard a lot of misdiagnosis stories about people's sister's niece's daughters having meningitis which was totally missed. However, I can't honestly say I know anyone personally who has had problems, and while callback times can be lengthy, they've always given me good advice when I got through. On one occasion, with appendicitis, it was NHS Direct staff who urged me to go to the doctor as soon as the clinic opened and probably saved my life (I thought it was just a REALLY BAD virus or food poisoning). In another, a couple of weeks ago, when my chest seized up after the flu, a doctor called me back and chatted to me, checked my symptoms, and told me what symptoms I should watch for because I'd need immediate medical attention (After a week of flu not being so bad, my chest suddenly went very tight which was just plain scary. I couldn't remember how bad it SHOULD be before not breathing was something I needed to worry about).
Opticians
Okay. Raise your hands. Which UKers were victims of the horrible beast known as.. NHS glasses.
*raises own hand*
When I was a kid, all under 18s got free glasses as needed. Which was awesome. Except that, if your parents couldn't afford a bit extra for the frames, they were ugly as hell and you were marked for life with your awful, awful jam-jar specs.
At some point though, the opticians wised up. They realised that most kids didn't have eyes of MAGICAL FIXINGNESS and in most cases they were gonna need glasses or contact lenses for life. This meant that it was better for them if, as soon as they hit the age of majority, the kid didn't rip the glasses off and swear to be happily blind forevermore. Nowadays, no matter how poor their parents are, most kids can get glasses in actually quite pretty frames. Again, the unemployed, pensioners, and those on certain benefits can also get free specs.
If you're working, however, it gets a bit more complicated.
If you're in a job which doesn't involve a computer screen, and you're on no benefits, and you aren't actually one step from blind, you're out of luck. You're buying your own glasses or contacts.
If you're in a job which involves display screen equipment, your employer is obliged to foot the bill for you attending an eyetest once every two years. If that eyetest comes back with you needing glasses for display screen equipment your employer is then obliged to supply you with a voucher. You can then hotfoot it away and get your glasses or contacts up to the value of that voucher. If the ones you like are too much, you are allowed to top up the amount.
Note the careful wording there though. While my last (slightly crooked) optician was happy to sign that I needed a voucher, my current (much better) optician will gently point out that without glasses I would have problems finding the sign. No voucher for me. If my left eye was slightly worse I would receive NHS help with glasses funding. As it is, I pay for them myself. LIFE IS SO HARD.
In all seriousness, I would be fully behind more even provision for eyecare, just because I share a road with these people. I don't particularly want to be driving in front of Jimmy, who hasn't been for an eyetest in four years because he's scared he can't afford the new glasses, you know?
Day to day care
In all honesty, if you asked me five years ago about getting a doctor's appointment I would have gone into a pissy rant about how you could never get one out of working hours, and you had to wait five days for an appointment because they liked you to be good and sick.
Two years ago, you'd have got another pissy rant. We had walk-in centres where you could go and wait to be seen if you lived in a city, but out of cities was another matter. I distinctly remember one receptionist making me cry. I called up post-appendicitis, because my stomach was hurting which I had been told was a potential sign of infection (very bad -- can kill you). I was working 12-8, in a new job where even taking time for a doctor's appointment while on probation would result in me losing it. I could not afford to lose my job. I explained, I begged for an emergency morning appointment, and she told me that if it was a real emergency I wouldn't be at work. (I believe mum later made an official complaint).
Now though. Now is a different matter.
There are walk-in centres now, operating seven days a week, even out of the city centres. I mean Teesside has one, for God's sake -- it's hard to find, but it's there. You can ALWAYS go wait there for an appointment. My regular doctor opens late Monday evenings so that working folk don't have to skip work. And while you might have to wait a while to get through if you call when the doctor opens, they can almost always get you a same day appointment, and they will try to work with you to find a good time for you.
I cannot overstate how awesome this is when you're coughing your guts up, or clutching a throbbing ear, and can't afford to leave work at lunchtime, drive home and then drive back. It is awesome. Also, free.
Perscription charges
If you are under 18, on certain benefits, or a pensioner, your perscriptions will all be entirely free. Painkillers, antibiotics, whatever -- doesn't matter. They go, get their meds, come home. Free.
Otherwise, you pay £7.20 per perscription. Doesn't matter what for. If you're going to need a lot, you can pay £28.25 which will cover your charges for the next three months, or £104 covers you for a year.
Birth control is always free. Some illnesses -- I know thyroid is one of them -- you will receive your drugs for free. I was told that this is because these illnesses do not immediately kill you if you don't get your drugs, so people who are struggling may be tempted to put off getting their next lot in order to make bills. I'm all in favour of people not dying, although it can sometimes seem a bit hit and miss as to what falls into this category.
Emergency care
This is where it matters. And where it matters, the NHS is there.
I've mentioned the appendicitis a few times. Two years ago, I started having cramps that felt a whole lot like period cramps. As I do for such cramps, I took ibuprofen and ignored them. When I started feeling REALLY bad a few days later, I blamed indigestion. Then food poisoning. Then a virus. Finally, at 6AM in the morning, after throwing up every 15 minutes through the night, I called NHS Direct.
They directed me to the doctor. If I had been alone in the house -- my mum was there -- I believe they would have sent an ambulance. The doctor sent me to hospital. Again, if I hadn't had my mum there to drive me, transportation would have been provided.
There was no waiting in the A & E room at the hospital. The doctor had called ahead, and I was wheeled straight through to a bed. No form-filling, you'll note, except for the "Please rate pain on 1 -10" and "Are you pregnant?" I was given a morphine shot. I was sent for scans that day. And the next day, I was sent for my appendix to be removed.
It turned out it had already ruptured, leading to peritonitis. I was kept in hospital for five days -- they nearly sent me home on the fourth, but decided my bloodpressure was too low. Cost was not an issue. Knowing I was safe to leave was.
I was provided with about four different antibiotics and painkillers (it turns out codeine hates me, but that's a different story). A few weeks later, when I overdid it, and it started hurting, and we were scared of infection, I was sent back. Again, scans were done, I was kept in overnight and then sent home.
All of this, other than the meds, were free. I paid £7.20 for each of the packets of pills.
When I passed out at work, scaring my boss half to death, and the doctor picked up a heart murmur, I was referred right-quick to hospital for checks. Similarly, when the baby sister applied to join a gym and they picked up tachycardia (heart beats too fast), that was a very quick send-on.
Lest you think that my life was spared due to not being old and due for a death panel, the NHS also got my grandfather through several strokes -- and they were patient with him even when one made him so confused and panicked he took a swing at one of them (and even at 70-odd, my grandad was a big strong man). My great uncle had his first heart attack the year of my birth. He had a pacemaker fitted. He died, after several more heart attacks in his life time, when I was 21.
Pallative care
This is where it would be easy to cut care, which is why I twitch again at the whole "death panels" idea.
Look, as some of you guys know, my cousin had a car accident when I was tiny and he was 17. It was a bad one. There was severe brain damage. The option to turn off the machines was given then, and several times over the years that followed at times when he became worse. It was never taken (whether it should have been is a discussion for another day) and even though there was no option of my cousin ever recovering much, no pressure was put on my aunt by the NHS to make that choice.
The NHS provided help (although there was a compensation pay-out which also helped) to get their home converted so he could live there. It was instrumental in this, and that was the difference between my cousin living his last days permanantly in a hospital bed, and his last few years at home with family coming and going around him.
After he died, my grandfather (not the one who had the strokes) had his own health issues with asbestosis. If you don't know what this is, it's a horrible illness which comes from exposure to asbestos -- particularly horrible if you don't have free healthcare because most of the people who have had this exposure are likely to be blue-collar guys without much cash. It is incurable. Again, the NHS provided oxygen and help to keep him at home until he absolutely had to go to hospital at the end.
I'm not saying that it couldn't be improved. There's a lot I'd like to improve here, including lifting carer's payments to an actual amount it's possible to survive on. But the NHS certainly didn't give up on them.
Referring to Consultants
And now after praising them mightily, I must damn them mightily too, because this is where they can fail -- in that gap BETWEEN "someone is dying and needs immediate care" and "this person needs antibiotics". If you have something that needs more than a GP and less than an urgent hospital visit.. yes. That can be rough. I hear that you folk in the US get gyno visits if you're on the pill any length of time? We don't. And yes, there are waiting lists, and it can take an age, and... they're trying to get better. But it's still pretty bad in this area.
They have the same problem with mental health care. You must be referred for mental health care. For several years now, I've been struggling with winter anxiety and depression -- possible SAD. When it gets to its worst, I go to my GP and ask to be referred. Sometime later, in mid-summer, I get a phonecall to schedule an appointment. THREE GUESSES WHY THIS DOES NOT HELP.
Preventative Care
Woo, hit and miss! Americans don't necessarily have MORE jabs than we do, but I believe we have different ones -- we don't get flu, but I believe you don't get meningitis ones? (UKERS! POP QUIZ! SYMPTOMS OF MENINGITIS AND NO PEEKING AT THE COMMENTS TO CHEAT!) Actually, I've never heard a US-side person talk about meningitis much which throws me -- is it not an issue there? We had a kid in my year with it when I was at school.
The jabs we do have are getting better now, but we had a few years of sketchiness. The baby sister (who is actually 21, for purposes of clarity) and I fall in a group which only got half our MMR jabs for some weird reason, which means we're still a risk for measles, and at one point were quarantined for potential mumps. Also, we both had chickenpox (in my case, the day after a wedding. I'm just awesome like that) They're now vaccinating all 14 year olds against cervical cancer, and checking those over 25 for it, but, uh, if you fall in that hole between the two you're doomed?
On the other hand, a few months ago we sent a roadshow around the UK to check the heart of anyone under... 30, was it? for anomolies, as heart failure in the young can hit suddenly and without warning. And, as I pointed out in the other post, the joy of illness is that it doesn't appear with girt big I AM SERIOUS signs. A lot of heart attacks -- especially in women -- are missed because a mild one can pass and they don't want to make a fuss over what was maybe nothing. As the second one can then kill you, I'm all for getting that maybe-nothing checked out for free.
Experimental Methods
I'm going to stop soon, because my arm is starting to hurt.
Someone highlighted in the previous posts that the NHS will sometimes block expensive and experimental medicines. Which, yes. Is true. That doesn't meant that we never take a chance. or that we can't be awesome.
Sometimes, it's just that a drug is too expensive and has too low a success rate to be available. The person does then have the option of going privately, or sometimes arguing with the NHS can lobby them to change their mind. It has happened before. It should be noted that people too poor to get these drugs privately in the UK might also be too poor to afford the insurance that would cover that particular drug in the US also.
I would like to see changes in this area however. I would like to switch to a method where, in these circumstances, someone could "topup" NHS care with payments of their own, instead of the current stark choice, under these circumstances of "PUBLIC OR PRIVATE, THERE IS NO IN-BETWEEN."
Or, you know, we could set up all drug companies as nonprofits so the drugs aren't so expensive in the first place. But I can't see that one happening somehow. ;-)
My arm hurts now, so I'm stopping. But I will finish with these figures from the Beeb on life expectancy, expenditure and infant mortality. They make interesting reading.
Questions? Anecdata? Arguments?
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