Liberty and Medicine

Monday, August 06, 2007

A snapshot of socialized health care in one country this week.

I lived in the United Kingdom just enough to know what Michael Moore has denied -- there are long queues of people waiting for care from the National Health Service. Michael seems to think people waltz right in and are treated immediately.

I tried an experiment with Google news search last night. I typed in just two things. The first was the abbreviation for the National Health Service, NHS, and the word “waiting”. Remember since this is a Google news search it only searches for a specific period of time. These are not old stories but news reports on the current situation.

The first report I want to mention is from the Independent newspaper. What makes this story different is that a senior trauma surgeon is breaking NHS rules to speak out. Physicians, nurses and other employees of the NHS are forbidden to speak to the media. Transparency is not their middle name.

But Martin Bircher talked because he said he couldn’t endure the suffering that patients were being put through. He described, “a system paralysed by red tape and disputes over funding, which is putting thousands of patients waiting for treatment in specialist wards at risk.” The paper says:
Every one of Britain's specialist trauma beds is full, which means some patients can wait up to three weeks after their accident before badly broken bones can be repaired. The delay, says Mr Bircher, can jeopardise recovery. With nothing but praise for frontline staff, he says patients who have been critically injured in road or other accidents have to wait an average of 12 days – often in agonising pain – before they can receive the vital specialist treatment.
These a victims of severe trauma who are being denied treatment not people with earaches or sore throats. But trauma beds are expensive and the way socialist systems provide medical care cheaply is by restricting access to expensive treatment. They don’t want more trauma beds being used because it drives up costs and that destroys the illusion of the efficiency of socialist care.

Trauma care is limited to certain hospitals. Patients needing this care are first treated in a regular hospital and then have to be moved to the trauma units later. But NHS bureaucrats,
...are involved in making the final decision as to whether a patient can be moved. If they have to move them there is often a conflict or reluctance because the new area does not want an extra cost. So after initial admission to a general hospital’s emergency wards, where lives are saved, patients can find themselves waiting up to three weeks before their real recovery process can begin.
Bircher says that the physicians and nurses are doing the best they can “but are hampered by layers of managers whose major concern is the budget rather than patient care.”

The paper reported the case of a young woman, Lucy Lynn-Evans what was riding a scooter when a truck smashed into her and ran her over. Her laptop, in a backpack, saved her life since it took the brunt of the force as the truck rolled over her spine. But her pelvis was smashed to pieces. The local hospital stopped her from dying but only a few hospitals in the country are given the speciality equipment needed to repair her pelvis. She was put on morphine for pain and told it would take three weeks before a bed would open up in one of the hospitals equipped to deal with her problem.

Lucy said the pain was so bad she begged father to take her to the other hospital and dump her on the steps if necessary thinking this might speed up the wait. Other patients were considered more urgent and Lucy kept losing her place to those with more need. When a bed became available the local hospital fund manager had to approve the transfer. He didn’t show up to work until 9:30 that morning and by the time he reached the form for Lucy the bed that was available was gone. Lucy’s mother knew some of the top NHS officials and was able to use her contacts to create a fuss and get Lucy into a bed early. She confessed she felt awful doing this, “I know that in securing a bed for Lucy someone else had to wait longer.” But one reality is that under socialized medicine people with political pull can jump the queue.

Next from Aberdeen comes this report about desperate dental patients seeking help from the NHS. Recently, the Aberdeen Evening Express reported that there are 25,000 people waiting in line for care with NHS Grampian “meaning it could take years before a NHS dentist is available.”

One local patient was having trouble getting seen for a filling. He signed up for a low-cost private care program for two check-ups per year. He then discovered that NHS decided to punish him for doing this. They dropped him back to the bottom of the queue telling him that since he paid that this proved he was not in need and thus not urgent.

The Norwich Evening News for July 30th, reports that their local NHS is making an effort to cut the waiting lists. Under a new “Choose and Book” plan patients, with their GP, can actually pick the hospital of their choice for treatment. You would think that normal. But it wasn’t. What is truly revolutionary is that the NHS, to cut down waiting lists is now allowing patients to seek care at private hospitals. The paper reports: “Now a contract between BUPA Hospital and Norfolk Primary Care Trust means thousands of patients will be able to get seen by a specialist in a much quicker time.”

A business manager for the private hospital says, “It means people can be treated closer to home or work.” So to cut their waiting lists the NHS turned to private hospitals to help with the work. Hmm, do you think Michael will mention that?

The Scotsman reports on one hospital that did manage to cut the waiting time to get admitted to hospital. Last year one-fifth of all patients waited more than four hours to be admitted, discharged or transferred at this hospital. The hospital was happy that last week it managed to get it down to 3%. That’s good but does one week make a trend? And this hospital is being praised because it is the exception, or at least was the exception one week.

In another story the Scotsman reports that NHS Lothian was crowing about how they are dealing with cancer patients who are referred for “urgent” treatment by their GP. Please remember this is “urgent” care requirements for cancer patients. That is not something you wait for. Their goal is to have 95% of these urgent patents treated within two months. Two months? What would the waiting time be if the case were not deemed urgent?

Of course 5% of those patients will be waiting over two months, if NHS Lothian reaches its goal, which it hasn’t. Last month 12% of the urgent cancer patients had gone more than two months with no treatment. I’m still wondering if two months waiting for “urgent” cancer patients is all that successful. Surely with urgent cancer cases even two weeks is unacceptable.

Another recent report says that there are 2,474 NHS dentists working in Scotland. which is 173 more than last year. And the budget has increased by about another $200 million. Yet the number of patients registered with a dentist has actually declined. It was 49.9% in 2000 and 46.2% currently. It also reported: “In some areas, less than a third of adults were registered with an NHS dentist.” There are around 58.4 dentists per 100,000 Americans or one dentist for every 1,712 people. Each dentist in Scotland, under socialized care, has to treat 2,068 patients. So there are considerably fewer dentists relative to the population. Fewer paid dentists, with long waiting lines, is a way to keeping costs down.

We previously reported on a 108-year-old woman in Deal who was told she would have to wait two years for a hearing aid. So it is somewhat of a relief to report that the waiting period in Scotland is not quite that bad. Patients in Lauriston Place were only waiting up to ten months, in Livingston it was a wait of 35 weeks, in Edinburgh they can wait up to 43 weeks. The NHS target for Scotland is 26 weeks -- that is what they consider the goal that they would like to reach If I couldn’t hear I’m not sure I’d consider a 26 week wait all that lovely. But no worries since they haven’t come close to even this modest a goal.

I also came across a report from Malta, of all places, about NHS care. It reports that more patients from England are flying to Malta for health care. It reports:
Due to lengthy NHS waits and concerns about the high risk of MRSA infections in NHS hospitals, a growing number of Britons are taking advantage of affordable, high-quality private healthcare abroad, combining it with a relaxing holiday. They save thousands of pounds compared with having the treatment done privately in the UK. Already, many British patients travel to Belgium, Hungary and Poland and even further afield to countries such as India and Brazil.
MRSA is a bacterial condition caused by unclean conditions and it seems rather prevalent in NHS hospitals. In 1999 there were 487 deaths from the infection. But in 2003 it had risen to 955 deaths. And a report in the Daily Mail for February 4, 2005 said that “hospital-acquired infections overall strike around 100,000 people each year in England”. They also report that the health care workers union says the number of MRSA related deaths is actually much higher because many death certificates don’t mention MRSA as being a factor even when it is. But not that is old material and my focus is on current stories. But apparently MRSA hasn’t diminished much if the Malta report is correct.

In Ambleside NHS dental patients were in for some bad news. The local dentist is getting on in years and retiring. And he won’t be replaced. He has 3,000 patients registered with him and more on a waiting list who can’t get in. The 3,000 patients will have to try to get on the waiting lists for dentists in other towns.

I will stop with this next story but these are only the first few stories that appeared in my Google search. There are many more. The last one is interesting because it contrasts care under the NHS and care in the United States. The story is about Fraser Brown, the young son of the Prime Minister. Fraser has cystic fibrosis. The first point that I found interesting is that the average life expectancy for a patient with cystic fibrosis in the UK is 31 years, two years less than in the United States. But it also revealed that some US centers have managed to get life expectancy up to 47 years.

And this article compared how this center operates versus the best in the UK:
Successful treatment of cystic fibrosis requires extraordinary commitment, attention to detail and a refusal to accept second best. While the average centre might accept lung function at 75 per cent of normal, at Fairview they are not content with 80 or even 90 per cent. They aim for 100 per cent. They question everything they do and act immediately when standards slip, rather than accepting it as an inevitable by-product of the illness. In Britain, we do not think about medicine in this way - as a daily battle against the forces of sickness and decay in which every centimetre of ground gained deserves celebration, and every centimetre lost explanation.
It tells how the Cystic Fibrosis Foundation in the US has published the success rates of every one of their centers on line for the public to read. Physicians can see who is doing better and perhaps learn why. Patients can pick the center with the best performance. Not so in the UK. In principle there is an agreement to do this, eventually. But “directors are worried the data may be misinterpreted and used to beat ’under-performers.’”

The article suggests that the UK needs to learn how to compare performance between services. It says the Brits need “a healthy dose of American belligerence” to do this. But why do Americans compare between service providers? Because in the US the providers compete and Americans are not normally assigned to a specific provider with no other option.

There are over 600 more stories in the last few weeks. Perhaps not all of them about the National Health service and waiting times. One was about a high school football player who attended a school abbreviated NHS. But many of these stories are. I didn’t cherry pick. I just went down the list and opened up and reported what was said. But I will cheat on one story that I saw which was further down the list. It’s one of those “good for them” stories.

Tony and Greta Dodd are both pensioners. And they have a common problem with old people. Both of them suffer from knee problems. Tony’s knees went first. Then Greta followed suit. Even a short amount of walking puts them in excruciating pain. Tony says: “I’ve been on the NHS waiting list for six months and up to now I’ve heard nothing, not even a proposed date for an operation.”

But Tony and Greta got lucky. No, the NHS didn’t call them with new knees. Better. They won the lottery. And they plan to celebrate by going private and buying new knees for the both of them.

And the great thing is that they won by accident. Like so many people they play the same numbers week after week. But Tony went to the newsagent to purchase a ticket and forget the slip with the numbers on them. Well, with bad knees he wasn’t walking back home. And so he tried from memory. He could only remember the first five numbers correctly and so for the last one he picked a number randomly. In his case it certainly was true: he had more of a chance in winning the lottery than getting the surgery he needed from the NHS.

The reality is that Michael Moore was fudging the facts when he implied that British health care is so wonderful. The daily news stories from the UK indicate a system that is mired in debt, bound up in red tape and constantly denying care to people in order to vainly attempt to lower health care costs. One British columnist, Giles Whittell, of the Times of London even challenges how much cheaper it is than US care.

He pointed out that last year the NHS had a budget of around
...£104 billion. That’s roughly £1,733 per man, woman and child. Multiplied by four for a typical two-child family, then divided by 12, that equates to median monthly family healthcare expenditure of £577, or $1,155 in American money. I can buy some very respectable US health insurance for $1,155 a month. In fact, on a quick and painless stroll through the web site for Kaiser Permanente, a leading nonprofit US healthcare provider, entering my basic family details and the Beverly Hills zipcode, the most expensive family policy I can find that does not depend on contributions from the state or an employer costs $400 less than the sum Gordon Brown currently chooses to spend from my taxes, each month, on the NHS.
I don’t know anyone who says there aren’t problems in the US health care system. It certainly is a bastardized system of conflicting incentives and regulations many of which harm consumers deeply. But there is this blind, utopian vision of the virtues of socialized health care that can only be compared to religious belief not rational policy making. And as this snapshot would clearly indicate one can not produce a “documentary” which deals with British health care, and do the smallest amount of reading, without being aware that these problems are rampant. If the documentary then appears to give the opposite conclusion the only warranted conclusion is that the documentarian is dishonest.

Photos: Our first photo is the fabricator himself. The second photo is an actual queue at an NHS dental service that announced it could take 300 additional patients. Hundreds more turned up than could be accommodated

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