A note on Britain's NHS
I haven't posted anything at the Cafe for a fortnight because during this time I have had to make use of the NHS. That this coincided with the blow-up this side of the Atlantic after a Conservative politician mouthed off on Hannity that he "wouldn't wish the NHS" on anyone was personally serendipitous.
By way of some background, I am in a good job at a large firm, and I am enrolled in the private healthcare plan available to all employees. And I am very pleased that I have this option, because it provides me, my wife and our young daughter with the best access to specialists when we need them. For example, I contracted Lyme Disease last year, and without private insurance I would have struggled to find a true Lyme specialist (the illness is still rare in the UK). Our daughter suffers from hypolactasia, and without private insurance we might not be able to see the gastroentologist recommended to us by our (NHS)family doctor.
For those that aren't familiar, many doctors, and in particular the specialist physicians, work both for the NHS and in private practice. When you have a particular medical problem that requires a specialist consultation, and you are going through the NHS, what you don't have is the luxury to choose your specialist - at least in the first instance, you go with who is available at the time.
So in this respect, private insurance is invaluable.
But two weeks ago, when I started to experience stomach pains, my first step was to try to arrange to be seen by our family doctor. She had no spare appointments for the afternoon, but agreed to call me when I got home and then see me the following day.
The pains got more severe however, so instead of going home, I called my wife and asked her to come pick me up from the train station and take me to the ER. I, like all us mere non-medically trained mortals, had no real idea what was going on though I am aware how dangerous something like appendicitis is.
The timeline from arriving at the ER went something like this:
2.00pm - Report to the reception. ER is full, am told I may have a 3 hour wait to see a doctor.
2.10 - Seen by a nurse who takes my blood pressure and pulse, and gives me painkillers.
2.20 - Second nurse takes blood for testing.
2.30 - Go back to reception to say the pains are worse, the painkillers have done nothing.
2.35 - Doctor calls me through into the ER. Given a private room, a gown, stronger painkillers, and container for a urine sample.
2.45 - Doctor tells me to go through for chest and stomach x-rays.
3.15 - Short wait to be x-rayed, but that's done, and I go back to the private room where I am put on a drip.
3.40 - ER doctor comes back for a further examination. What relief I had had from painkillers has worn off and when she starts to examine my stomach, I hit the roof. She gets more painkillers and says a surgeon is coming down to see me, but everything suggests a type of hernia.
4.00 - Surgeon visits, tells me it's an incarcerated hernia, they need to operate. Will do it as soon as possible, but in the meantime I'll get taken to the ward where I will be spending the night.
4.30 - Taken up to a urology ward, shared with five other patients. Checked in by ward nurses, drip replaced etc.
5.00 - Nurse tells me they probably aren't going to be operate that evening, but more likely early the next day.
6.00 - In major pain at this point, immediately attended to by the senior nurse on the ward, end up getting doped up on morphine. That's how I spent the night.
8.00am, next day - Taken down to operating theatre. Much of this day henceforth was spent in a daze, but the outcome was I was on my way home at around 8.00pm that evening with a bunch of stitches in my stomach, a bag full of drugs and sick note for work.
There are other details I could go into - the good (how flat-out the NHS staff work), and the bad (hospital food) - but the point here is (a) how quickly I was seen to; (b) how well I was cared for; and (c) that I came home 36 hours later with a clean bill of health without having had to shell out a penny.
I'm not about to look past the NHS's problems, God knows they exist, and I am very mindful that through having private insurance I pay for certain advantages. But my story from two weeks ago is that when I turned up at one of the country's larger NHS hospitals on a busy Monday afternoon urgently needing treatment, I got all the care I needed in extremely good time. And if a similar problem reoccurs, I'd have no hesitation going back to the same hospital.
The idea that this a system you wouldn't wish on anyone is, in a word, unthinkable.
















Thank you so much for this revealing narrative. We're so inundated by alarmist shouting on this side of the Atlantic that it's almost JARRRING to hear just a simple, factual, personal story.
One of the interesting points your experience hi-lites is something most Americans (even some who support NHS-style programs)don't always understand: The hybrid public/private nature of both British health insurance, and the practice methods of British physicians.
It doesn't appear to be the sort of clanking, rigid, "GUVT" program that many Americans take it to be. Instead, it seems to me it trys to take advantage of elements of BOTH approaches. Am I reading this correctly?
August 24, 2009 4:06 PM | Reply | Permalink
The system is hybrid, but I would guess confidently that the large majority of people in the UK use the NHS only, and don't have private insurance.
I wouldn't be so sure that the public-private system here occurred neatly through design, the growth of the private industry probably came about to meet demand for a premium healthcare service; the big logistical issue that has followed is to ensure doctors' contracts allow them sufficient opportunity to work in the NHS as well as privately (where they get paid more). Just about every specialist I know, however, wants to work both for the NHS and privately - aside from any moral motives, they find they treat a greater variety of ailments at NHS hospitals; also, virtually all training of medical students is done through NHS hospitals and a lot of doctors appreciate this aspect of their work as well.
Thanks everyone for the recs - what I didn't mention in the original post was that when I was told they were going to operate, the surgeon said I would either be in hospital after surgery for about 12 hours or 3 days, depending if there were complications.
Knowing what I do about what a private hospital charges for minor surgery under general anasthetic and a night in hospital, that cost is in the region of $4000 equivalent. The thought crossed my mind that were I living in America, I'd have had the layers of extra concern over insurance and exactly how I would have managed to pay for the treatment (the final cost of which was unknowable before the surgery).
I'm not sure how you put a value on taking away this uncertainty, but an extra few pennies in income tax seems a very small price to pay.
August 25, 2009 4:32 AM | Reply | Permalink
No one really knows how good or bad their insurance is until an inappropriate time where something happens all of a sudden and you need the service you think you have paid for. That's the only time you really understand the limitations of your policy and what costs you will have to bear. Minor cuts, bruises, stomach ache, constipation, ear infection, cough, nasal congestion, high temperatures, tooth ache or pain are nothing more than minor symptoms that are easily remedied. It's those ball busting medical problems that costs tons of money for the immediate medical procedures, drugs and services because it's life threatening that is the Come-to-Jesus clause in your contract which everyone never reads or doesn't fully comprehend just exactly what your insurance will and will not cover. If we have to wait until everyone has their Come-to-Jesus medical emergency, this health care bill will never get passed.
August 24, 2009 5:27 PM | Reply | Permalink
This Aug. 15 piece by Sarah Lyall: "Health Care in Britain: Expat Goes for a Checkup" seems to have the same general takeaway as your tale does!
The second half of it has her personal experiences. She is a reporter with the New York Times in London and her husband has private health insurance with his employer, and they have made a lot of use of both, she had a baby there and her husband had a serious stroke there in the 1990's. She clearly thinks that NHS primary and critical care is top notch, and that the private health insurance was most welcome if you can get it, for specialities. And of course, when it's a loved one, that icing on the cake can mean quite a lot.
I think it's important for people to always keep in mind that no health system will ever be 100% "fair," as enough money or power can always get you more than the average Joe is getting, even if you have to leave the country to do it, or do it by under the table payments. The true judgment of a system is how well and efficiently it offers the basics to everyone. The rich will always have better access to "quality of life," that's just the way it is.
And hey, congrats on making the right decision to go to the E.R. and not going home and waiting for the primary doc's call. Best of luck to you on the convalescence and follow-up.
August 25, 2009 4:24 AM | Reply | Permalink
Thank you for the comments and good wishes - I am doing a lot better two weeks on, right now just following the doc's orders not to do any heavy lifting etc for another month.
On one point from the NYT article, I think it is a decent generalization that primary and critical care is what the NHS does best. Speaking from my own experience, pre- and post-natal care is what the NHS does best of all. (In fact, I think a lot of private plans don't bother competing in this area.) It's when you want to see a particular specialist that private insurance becomes valuable. Also, non-urgent treatment gets done sooner.
But neither of these issues, despite being important to me, are quite as fundamental as having a system that is, as they say here, "free at the point of care".
August 25, 2009 5:02 AM | Reply | Permalink