What can you tell us Yanks about Healthcare in the UK

NHS administrator here. A few points I would like to address, in multiple posts. It's late and I'm tired. Tirade?:

Point 1: Re: profit-driven healthcare.

The NHS is awesome at some things, but I see no reason why it cannot be as easy to use as private care.

Very simple, very obvious answer to this: delicious money.

A tiny proportion of the 60 odd million people living in the UK will ever enter a private hospital. Those that do will, almost without exception, have money behind them, either in the form of an employer insurance scheme or a healthy personal bank account.

So why can't the NHS be more like the Private Hospitals?

Less Patients + More Money means that private hospitals have more time to do more tests on fewer patients.

It means they can buy more beds (and wine!) and better equipment, more often.

It means that they can train more staff more effectively and regularly, ensuring that less bad habits, both clinical and administrative, are picked up and perpetuated, less often.

It means that they can offer higher salaries and thus attract a higher calibre of (and generally younger, more computer literate) administrative staff who engage with that training better.

It means they can pay for more efficiently networked, better maintained Patient Administration Systems that are run on computers and servers which are constantly updated, maintained and renewed by a higher calibre (see above) of IT staff.

And so on.

Private healthcare works like that in the UK because the resources of the Private healthcare system are never stretched, and rarely tested, because they are used, almost exclusively, by this wealthy minority.

And that is why profiteering capitalists in the US champion it, because on paper, private healthcare is great. Everyone wins!

Where private healthcare fails (in the US and, hypothetically, here) is when you introduce** the World's famous Poor People** into the mix.

Poor People famously don't have any money to pay for stuff with, which is problematic when they need a rather complex neurological procedure. And let us make it plain now, that they do need it. We are all human, we all suffer health problems, these problems all need treatment.

Business Man, on the one hand, can pay out of his own pocket for a GP consultation on Tuesday, get a referral sent over to the consultant and hospital of his choosing on Wednesday. Then he can take his employer health insurance monies and go and get the procedure done at London Bridge Hospital the following week. He can again use his Large Salary to independently pay for any follow up appointments with GP as required and for any Big-Pharma drugs that are not covered by aforementioned insurance monies.

Poor Person, on the other hand, can work the same hours as Business Man for a tenth of the pay and, maybe, with some scrimping and saving, purchase a budget individual insurance plan from a company with a business model geared solely towards maximising shareholder profit and CEO pay packets (generally by selling large employer insurance policy packages to companies for which Business Man works).

When Poor Person gets ill, he discovers, after a week or two of paperwork exchanging and listening to ‘hold’ musak on a premium rate phone line, that his budget policy doesn't cover GP consultations on Tuesdays in June, or some thing like that. So he waits another week or two before he can see a GP. When it comes to the consultation, it transpires that he has an underlying condition brought on by something or other in his Poor Person Life that he was unaware of when he signed for this insurance policy, because he couldn’t afford to go to the doctor for a check-up whilst he was doing all that scrimping and saving. And, don’t you know it, that underlying condition happens to invalidate said policy. But he can still go get the procedure done if he pays a bit (£10,000) extra and agrees to an increase in insurance premiums for a few years.

So he does. And he turns up with this (now rather thick) stack of forms and a rather depleted bank account and is promptly given second class service because his record now has all kinds of black and red marks all over it that scream Poor Person. But he is eventually admitted anyway and he is assessed. And unfortunately, during the assessment, that underlying condition rears its underlying head, causes unforeseen complications and, because of the damn limitations of that policy, prevents the complex neurological procedure from ever taking place. Poor Person is promptly discharged Out of Pocket and sans Better Health or Prescription Drugs. And then gets worse and worse etc. [/life].

With the NHS, or ‘socialized medicine’, Business Man and Poor Person are treated almost equally, and both die later, aged 65 in an unfortunate d-lock through windscreen incident. The only disparity in equality is that those Big Pharma drugs still cost Poor Person a pretty penny, because those damn Big Pharma companies keep paying their Legal Teams hefty wages to ensure no one can produce cheap, generic versions of their ‘healing’ products for as long as possible.

And on it goes.

Oh, and lest we forget, Poor People outnumber Business Man about 40 to 1? That's a lot of extra admin.

So, to sum up

profit-driven healthcare - great for the monied few, killer for the massive majority of poor.
socialized medicine - Pro-life, for all.

Commie.

I try...

...

(good post, though.)

fantastic post actually, it just about highlight the whole difference between free health and private health.

And it's also bullshit.

Just what is it about the existence of "poor people" (and there are precious few really poor people in this country - here it means not being able to afford a second tv) that makes it acceptable that those who live in Tower Hamlets are denied treatments or drugs that are available to those who live in Shropshire? Or that money time and resources must be wasted sending patients back to GPs every time a referral is needed. Or that NHS money is used for quack practices like homeopathy instead of proven medicine?

It's not about the money. It's about the process. It's about the paperwork and bureacracy. It's about the political interference, and it's about the dogma. To those who ask 'so would you like the NHS abolished then?' don't be ridiculous. That's a straw man argument. Of course not. I would like it fixed. I would like it run properly. I would like it to be the envy of the world. And I simply don't believe that has to cost more. For every pound spent on the NHS I doubt that 50p makes its way to the front-line.

Speaking of "bullshit":

here it means not being able to afford a second tv

there are precious few really poor people in this country

jesus man where do you live? do you have any kids? do you understand what "being poor" means?
Its not all about buying tvs. I smell Tory...

And it's also bullshit.

Just what is it about the existence of "poor people" (and there are precious few really poor people in this country - here it means not being able to afford a second tv) that makes it acceptable that those who live in Tower Hamlets are denied treatments or drugs that are available to those who live in Shropshire?

Is it really bullshit? Bit harsh. Some some very clear and true points were made in the above post. Bullshit? Really? I'm American and I live here in the UK with indefinite leave to remain. I have experienced both ends of the spectrum and I can, in no way see the benefit of a profit driven private system, when the masses can't afford to take part in it.

I get where your coming at with the above comment about how many truly "poor" people there are and what constitutes being poor, but it's all relative. No we don't have a ton of truly third world poor people, who are starving on the street, we should be thankful for that. But we do have a huge class of people that are just barely getting by "the working poor". Relative to the huge amount of wealth that our western society has, these people are poor! In the US there are many many people who work their butts off many hours and days a week and bring home so little money they have to choose whether they can eat or buy medicine for their children. That sucks and as far as I am concerned that is poverty. The same class of people exist here in the UK and the rest of Europe, The difference being, that Europeans have the piece of mind that they will be taken care of no matter what their income. I have a feeling I might have missed the point you were making a little bit? If so feel free to correct me.

There is a downside I see to having the NHS so readily accessible. People seem to go to the A&E or to their GPs for some of the most rediculous things. I was Just in The A&E the other night with my girlfriend and we noticed the huge amount of people there who had little cuts on their hands or heads, people with colds or flu etc. WTF Is up with that? We had a conversation with the doctor that attended to us about this and she confirmed that a ton of people litterally come in to A&E to have a plaster put on a finger or other simple things like this! This is a serious case of HTFU! Americans are so deathly afraid of having to pay for medical bills, we need to be near death before we even think about the words "Doctor" or "Hospital". A simple visit to the ER in the US for a bump on the head can run into the $1,000s depending on wheather the doctor actualy touches you or not.

The NHS is indeed massively overburdened, and the above example is just a small one. Needless to say it needs to be fixed, It is suffering massively due to burocracy and politics. No matter what happens or what form the future of Health care takes in the UK, it needs to be accessable and easily available to everyone that needs it no matter what their income.

I smell Tory...

I think it's funny how conservative Tories seem incredibly liberal compared to Republicans in the US. Our Republicans are more like your National Front! God help us!

And it's also bullshit.

For every pound spent on the NHS I doubt that 50p makes its way to the front-line.

I think it's unfair to describe a well thought-out, informed post as bullshit, particularly when you're more than prepared to finish your own contribution with speculation. Administrative costs for the NHS run at about 5% of the total budget, so what else would you lump under the heading 'non-front-line'?

And it's also bullshit.

Just what is it about the existence of "poor people" (and there are precious few really poor people in this country - here it means not being able to afford a second tv)

What rot this is. You should come to the parts of Glasgow where the life expectancy for males is 53.9 years old, lower than in most third-world countries.

and there are precious few really poor people in this country - here it means not being able to afford a second tv)

Were you one of those people who applauded Willie Walsh the other day when he suggested the entire staff of BA go without their salaries for a month? Fine for him, losing £60,000 of £743,000. Less fine for baggage cart driver who loses £1,000 of £12,000. If you think we don't have a working poor in this country, there is little point in continuing any kind of debate about anything really. Because pretty much all injustice in society can be put down to the gulf that exists between rich and poor.

But I will continue anyway:

Just what is it about the existence of "poor people" that makes it acceptable that those who live in Tower Hamlets are denied treatments or drugs that are available to those who live in Shropshire?

On this point: nothing. It is unacceptable. It is also a direct result of inequality in society. Do some research on Practice Based Commissioning and Quality and Outcomes Framework. These two systems are central to the financing of General Practice. A **very **simplified summary of both:

*Practice Based Commissioning allows GPs to take control of their prescribing and referral budgets. *Imagine that we have a budget of 200,000pa to 'cover' the NHS treatment of patients we refer to NHS hospitals. If we refer less patients to hospital, and spend only 190,000 of that budget, we get to keep the 10,000 balance to spend on bettering our primary care service provision.

This seems like an incentive to stymie treatment for patients. It is not. It is an incentive to improve the way primary care is provided - opening longer hours, providing more appointments, providing better palliative care and active treatment of long standing conditions at the Primary Care level, and generally trying to be better as a GP surgery, which in turn reduces the *need *for so many referrals in the first place.

But if a patient walks in demanding a referral to some paediatric specialist at Great Ormond Street, because the patient knows, KNOWS, that their son has definitely got Autism because of that bloody MMR the GP made him have, then the GP might think twice, or rather, ask to see the son a couple of times, before making that referral.

It works to some degree. With the money my practice saved with PBC last year, we've been able to introduce a digital dictation system, which has greatly expedited the referral process at our end (we had sometimes a 2 week transcription backlog with tapes... now two days max). It has made all this 'paperwork' you dislike far easier and cheaper to manage - the only time we print anything is when the letter is totally complete, digitally reviewed by the doctors, signed with an 'digital' signature and ready to be posted. It also makes letters and referrals much easier to track and audit at our end, so when a patient calls up asking why they've yet to hear from the hospital, we can tell them exactly when and where we sent it. We will soon start to send our NHS referrals via email rather than snail mail - this will be yet another HUGE improvement.

We have also been able to introduce an Text Message based Appointment Reminder System, which has already started to cut missed appointments (thus saving us more money, and allowing us to reallocate cancelled appointments to patients who need them).

Unfortunately, and this is where your point is answered BlueQuinn, the disparity in practice income is directly related to the affluence of the area in which the GP is located. The practice at which I work reaps great benefits from PBC because it has a hugely affluent patient base. We can refer patients to private hospitals instead of NHS ones - they willingly go, so as not to endure the 'filth' of the NHS - and thus not sap any of our PBC referral budget and so on.

Not the case for Tower Hamlets GP it would seem. No (well, very few) private referrals there. No patients who use the NHS but have insurance to cover expensive drugs when they need them. This means more people have to draw more money from the Referral and Prescribing PBC budgets. Which in turn means no money to bring in digital dictation, or text reminders, or televisions in waiting rooms, or shift towards an entirely digital workflow like my practice has.

Very similar process with QoF. You get money based on meeting treatment and condition management criteria. When you need to ensure that 94% of your age 25+ female patient base has had a smear test in the last year to get maximum 'Points' (and 'Points' = Money) it helps when you can get all the 30 something mothers in for Smear tests whenver you like because they don't work and can, if needs be, leave the kids with the au pair, who came in for her smear test the week before. Many people just can't take time out of work for such things - particularly if they happen to be working full time for £12,000 in an un-unionised job. That is why we have a national problem, for example, with coronary heart disease. Try getting a full time working man aged 40+ in for a two minute blood pressure check with a nurse on a Thursday. It rarely, rarely happens, despite our practice opening at 7.30am three days a week and staying open until 8.00pm every single day.

I'll interject a personal opinion here: Both PBC and QoF are flawed, because they echo the bonus reward culture of the finacial services sector too much for my liking. They work well in areas of less social deprivation, where there are generally less chronic health problems and less demand on the NHS. The single biggest reform that could be made here is to introduce a redistributive element to any money saved via PBC - so my practice keeps £5,000 of the £10,00 saved, and £5,000 is redistributed to a practice that has maxed out its budgets and then some. That would balance things out a lot more. But the blame for the underlying inequality in society, which causes these inequalities in service provision - (and they are slight... we are talking 2-4% difference in PCT budgets from one area of London to another, if that) - cannot be laid at the door of the NHS.

Or that money time and resources must be wasted sending patients back to GPs every time a referral is needed.

Again, you misunderstand the process somewhat here. If you are treated as an outpatient (i.e. you are not actually admitted to hospital but attend for a day procedure) I don't understand how or why you expect to be ferried around St. George's as though things like schedules and other patients don't exist. All those other people who are inpatients, lying in those wards you only walk past are sicker than you. They get treatment before you because the medical professionals with their many, many years of training believe they need it more. You can't be squeezed in for a test, because the testing facilities are booked solid with the** sicker inpatients**. You can't reschedule your op for next week if a complication arises, becase the operating theatres are reserved for the sicker inpatients. If the clinicians thought the complication severe enough, or life threatening, you'd be seen in days. It is by and large their call, and they, with their medical knowledge, more often than not call it correctly. The majority of the super efficiency and proficiency of the NHS is reserved for the seriously ill, because they simply need it more.

Example: Cancer. If a GP suspects you have any form of cancer, you get an appointment at with the specialist most qualified and experienced with the suspected type of cancer within two weeks. Generally much quicker, but it is known as the Two Week Rule. You will turn up at hospital and you will get the works, because everyone knows that cancer kills.

Witness my father. Spent his entire childhood and adolescence running around shirtless in the South African sun. Is thus part of a know High Risk group for Melanoma. Upon being convinced by my mother to go see the GP about a mole on his back, he was sent an appointment four days later with the UK's leading skin cancer specialist who happens to work at St. George's. He got a biopsy done upon arriving, at about 10.00am, saw the specialist afterwards for a clinical examination, got the biopsy results back a few hours later, had the first batch of skin cancer cut out of his shoulder by 5.00pm. Went back two days later for a review and had a second (and, thankfully, the last) lot of cancer cells cut out. Now goes back for annual review with same world leading specialist. Lives.

That happened, because the GP, at the primary care level, knew something was seriously wrong, knew that skin cancer, if not caught early enough quite literally and without exception = death, and knew that he needed treatment immediately.

When you turn up at the GP with a jammy knee that you put out playing football at the weekend in the company of some friends, some decent beer, and no warm-up, to expect the same level of service is absurd.

Your girlfriend's problems sound less than pleasant, and it seems as though you have been exceptionally unfortunate at various stages along the way. Yes, the NHS is not nearly as efficient as it can be (I was halfway through a post specifically on what needs to be changed in my view before I fell asleep last night... i'll redo it later in this one), but equally, it doesn't sound like you made it particularly easy for yourselves.

My girlfriend had to register with a doctor in Shropshire and spend half the year up there because our local one in Tower Hamlets is snowed under with dole scroungers.

It sounds as though she maybe grew up in Shropshire, seeing this specialist, then moved to London some years later, which has hospitals, Primary Care Trusts and GPs that are entirely disconnected from Shropshire Country PCT. Presumably she changed GPs, had her notes moved down, and forth? Or did she decide she wanted to see the Shropshire based specialist as a result of research etc, and that was when difficulties began?

See I don't really understand this part.

A) either way, do you not perhaps think that *moving from a Tower Hamlets GP to a Shropshire GP in order to get the treatment you believe you need, whilst presumably continuing to been seen at Tower Hamlets GP as a temporary patient whenever you are in London, despite your notes being located in Shropshire, or is it Tower Hamlets, with some letters being sent to Shropshire address and some to Tower Hamlets address and no one really knowing what the hell is going on, yourselves included, *might create some additional bureaucracy along the way?

I don't mean that as a personal attack in any way... I am just pointing out the complexity involved in the action your girlfriend decided to take. Shifting from GP to GP is just not as simple as it outwardly appears.

also,

B) 'dole scroungers' have nothing to do with provision of primary care. Assuming we all have an equal right to treatment that is. Unless you believe those who don't pay tax shouldn't get access to healthcare? Which sounds a lot like private healthcare to me....

You also said earlier:

You should be able to choose your own consultant.

You can do exactly this, within reason. It is called 'Choose and Book'. As evidenced by teddy's post earlier:

i was referred to a dermatologist here in london, and was really unhappy with the care i was getting from him. so i did some research and found the world expert in the type of disorder i have, who practises in oxford. i asked my doctor for a referral to her. she's now in care over my skin problem.

Exact same story for my girlfriend and some rather acute issues she has had.

Choose and Book empowers patients no end. It just requires us all to do a bit of the leg work. The NHS provides all kinds of waiting time lists and statistics, and, as people contribute more and more to NHS Choices, we, the prospective patients should be able to read considerable numbers of consumer reviews of consultants, departments and hospitals around the country, enabling us to make more informed decisions about where and to whom we would like our GPs to refer us.

It's not about the money. It's about the process. It's about the paperwork and bureacracy. It's about the political interference, and it's about the dogma.

Wrong again. Unfortunately, everything is about money.

If you want less paperwork, we need an entirely uniform, exclusively nationalised digital administration system that provides digital interchange of referral letters, clinical examination reports, test result data, NHS hospital consultant notes, Private hospital consultant notes, gp consultant notes, homeopath consultant notes, private botox consultant notes, private cognative behavioural therapist notes, pharmacist notes, past prescriptions, current medications, current active problems, past significant problems, at every stage embedded with Electronic Patient Record meta data and heavy encryption to protect confidentiality, that can be accessed and contributed to by all healthcare practitioners.

Right now, there are god knows how many private companies that develop software for use in the NHS, with little to no compatibility between them, because that would undermine market share and competition.

Our practice alone uses one company, and server, for our Patient Administration System (PAS) (where your electronic medical records are kept), another for our digital workflow managment, another for the digital dictation, in combination with the standard windows/microsoft office package. We have a separate telephone exchange server thing (not my area??) maintained, it seems, both by BT and some other company contracted by the PCT to provide communications assistance.

We employ a 50 something year old woman whose sole job is to come in 4 hours a day, sit at a computer and scan in the 100 or so letters we get from hospitals each day, selecting a hospital and department from which the letters originate and the date of the clinic to which the letter is referring, assigning it to a patient's record, then sending it to a doctor to review, digitally.

When we recieve correspondence from any hospital, anywhere in the country, Private or NHS, there are almost always huge differences in data presentation that need to be made uniform to increase efficienty. Lister Hospital might write the date as [dd/mm/yyyy], whilst Guy's is [day of week-dd-month name-yy]. Private hospitals have an entirely different system of data presentation that doesn't adhere to any NHS guidelines anyway, and makes all our lives more difficult. Some hospitals have 'Geriatric Medicine' departments, others have shifted to 'Elderly Medicine'. Our digital document managment system thus needs to accomodate both. But sometimes it can't, because the only way to put these two categories in is by changing various fields in the PAS, and sometimes one piece of software just will not communicate with the other properly.

Now that seems like a massive paragraph of criticism, but it is not. We are so close to hitting a much higher level of efficiency - we just need more uniformity across the country. We could cut out the 4-hour-a-day woman if all the documents were sent digitally in the first place (although what she'd then do for a job, lord knows).

We need a public, ideally open source and extensive software programme to replace all these disparate private products.

We need a centralised database that all healthcare practitioners can access, to which they they can all contribute, that is run using this single piece (or suite) of clinical software.

We need people to enter data correctly when people swap GPs, and code diseases in the correct way, so that when you run a SQL search of your practice population, you can flag up every patient who is due a diabetic review in the next month, cross check that again people who have opted in to the Text Reminder system, and send the balance a text message reminder asking them to book an appointment for this review.

When a GP refers someone to hospital, they should be able to select various data fields on the EPR - relevant consulatation notes, medications, problems, intial diagnoses and contact details - and mail merge them into a 'letter' that is concurrently sent to the relevent department at the hospital to which you are referring the patient and automatically logged in the patient's EPR.

This might seem like an unachieveable fantasy, but it is not. It just requires us to get rid of the hundreds of different private companies on which the NHS currently relies, whose massively varying practices cause more harm (and paperwork and The Dreaded Bureaucracy) then good.

It also requires much better computers than most GPs and Hospitals have, as well as a younger, far more computer literate workforce who have the time to learn, and the flexibility to accomodate dramatic change in The Way Things Work.

They need to be prepared to work for less money than in the private sector and to deal with a far more diverse range of people ethnically and financially, who are young, old, have mental problems, or cancer, or need physio so SO badly, or have cut their hands, their heads or been stabbed in the liver by some evil young man outside a bar on Kingsland Road.

And it all requires more money. But no one is really prepared to pay. Because some of their money might go to a 'dole scrounger' in Tower Hamlets instead of their brother, or a grandma with emphysema in Manchester instead of their grandma who needs a GP check up after her private hip replacement. Might sound trite but it is basically true. For the NHS to work as efficiently and effectively as possible, language such as 'dole scrounger' needs to be removed from the collective national vocabulary.

You blame the NHS, and political interference, I blame market capitalism, social deprivation and a lack of understanding.

I have one more point to make, regarding frivilous and unecessary GP and A&E visits touched upon by various people - a huge and costly issue for the NHS, but I'll do it later, because I still have not had breakfast.

Sorry for the lengthy post and any typos.

Do you work for Guy's?

nope.

That was the best-informed post I've ever read on here, if not the internet. Fascinating.

And totally agree with you re: QoF.

Great post, hladik.

That was the best-informed post I've ever read on here, if not the internet. Fascinating.

+1

You make a lot of presumptions. Chiefly that I am anti-NHS. I'm not. I agree we need it. I don't agree that currently it is fit for purpose.

You also assume that I am some kind of "I'm alright jack" right-winger. Well I'm not. I have lived on far far less than the £12000 figure you seem to think constitutes poverty.

Were you one of those people who applauded Willie Walsh the other day when he suggested the entire staff of BA go without their salaries for a month? Fine for him, losing £60,000 of £743,000. Less fine for baggage cart driver who loses £1,000 of £12,000. If you think we don't have a working poor in this country, there is little point in continuing any kind of debate about anything really. Because pretty much all injustice in society can be put down to the gulf that exists between rich and poor.

Well as I have never had a holiday this century and was only able to afford my first plane trip a mere two years ago I have taken no interest in BA and have no idea who Willie Walsh is. But nobody should have to forgo money they have earned.

Unfortunately, and this is where your point is answered BlueQuinn, the disparity in practice income is directly related to the affluence of the area in which the GP is located.

The answer to this problem - the postcode lottery - is surely to stop allocating local budgets and just have one enormous central budget that pays for everything according to need.
[/quote]

Again, you misunderstand the process somewhat here. If you are treated as an outpatient (i.e. you are not actually admitted to hospital but attend for a day procedure) I don't understand how or why you expect to be ferried around St. George's as though things like schedules and other patients don't exist. All those other people who are inpatients, lying in those wards you only walk past are sicker than you. They get treatment before you because the medical professionals with their many, many years of training believe they need it more.

I don't misunderstand the process. You make massive assupmtions about our case. Would you class major spinal surgery as serious, perhaps? My girlfriend was at her bloody pre-op medical before being admitted to Stanmore to have a disc removed, an existing spinal fusion broken and realigned, the vertebrae jacked up and her fusion (which goes from her shoulders to her hips) extended so that she would only have one lower vertebra that still moved. That serious enough for you? Or do you think she should have hardened the fuck up after waiting 18 months for the damn appointment, and fucked off home? Your patronising attitude is just what the NHS could do with less of. You have no idea what a relief it was to have finally got the appointment after years of crippling pain. Or the crushing dissapointment of being told that your blood pressure was too low and being referred back to your GP, who then had to refer you a clinic in Manchester, who then could not do the tests because their equipment had broken, and then to have your operation cancelled, and to face another 18 month wait in agonising pain. That simply would not have happened in the private sector. In fact it didn't. They called the anaesthetist. He took a look at her blood tests and said it would be fine to operate.

Example: Cancer. If a GP suspects you have any form of cancer, you get an appointment at with the specialist most qualified and experienced with the suspected type of cancer within two weeks.

No you don't. Your dad may have done, but when my girlfriend had suspected breast cancer the soonest they could do a biopsy (which thankfully was all clear) was over three months.

Your girlfriend's problems sound less than pleasant, but equally, it doesn't sound like you made it particularly easy for yourselves.

No, being born with a potentially fatal 120 degree spinal curve must be so fucking inconvenient for the NHS. We are contrite.

It sounds as though she maybe grew up in Shropshire, seeing this specialist, then moved to London some years later, which has hospitals, Primary Care Trusts and GPs that are entirely disconnected from Shropshire Country PCT. Presumably she changed GPs, had her notes moved down, and forth? Or did she decide she wanted to see the Shropshire based specialist as a result of research etc, and that was when difficulties began?

See I don't really understand this part.

Let me explain it to you then. She didn't grow up in Shropshire.
Well what actually happened was that Tower Hamlets would not pay for her painkillers. They would not pay for her specialist - the one she had had since she was a baby. So she ended up for some reason referred to a hospital in Oswestry where the scoliosis specialist was cheap (but useless). Her friend lives there so she stayed with him. She had to go to a GP. She explained everything and he told her to register with him and she could get the drugs she needed. So she did. She is no longer registered with tower hamlets. She basically moved up there and lives in her friends house. She never uses Tower Hamlets GPs. All her official residence stuff is there, she pays council tax there (and here) and she spends half her time up there.

That was the best-informed post I've ever read on here,

Admittedly that's not saying much but I was about to say the same thing:)
Now, Hladik, about my bottom bracket...

BlueQuinn... I was not intending to antagonise or attack you. When I used the word "you" for much of that post, I didn't mean 'you' and your girlfriend... but us as a nation... a collective you if you will.

I didn't make that clear enough and I apologise.

I didn't (and still don't, after the summary you have posted) know all the facts of your girlfriend's case... I will say again, you have clearly had a terrible time with the NHS... nothing anyone can write will change that, and, without copying half her medical record onto a public forum, the only explaination anyone could possibly offer up would be nothing more or less than conjecture.

I am glad that the private sector served you well, and that whatever risks the NHS clinicians saw in her blood pressure were not borne out. That does not change the fact that private healthcare is a service provided by people with money (except for all the menial workers who actually make the hospital tick who are still paid less than a Living Wage), for people with money, at the expense of people without money.

One thing I will say is that it is probably not the fault of the Tower Hamlets GP that they were unable to subsidise the painkillers. I will make the assumption that they were not a generic painkiller, (because generic painkillers are generally inexpensive) but a patented product that a pharmaceutical company was charging an arm and a leg for.

That Tower Hamlets couldn't provide them free is the fault of the private sector charging so much in the first place. Nothing to do with the NHS, nothing to do with dole scroungers. It becomes, unfortunately, a matter of utilitarianism... if, for the price Glaxo-Smith-Kline were charging for the painkillers, TH could provide free generic insulin for 40 patients... well. It is not ideal. It is a matter of money. If they were a generic painkiller, I apologise again, and can only say that I'm at a total loss to explain.

There are those that would make the counter-argument that the drugs wouldn't exist at all without the private sector, which is true. That does not mean that drug companies should hold public bodies (and by extension, the public) to ransom so they can pay their CEOs giant bonuses and bump their share prices.

And on the cancer... I have no idea when or where your girlfriend went for the breast cancer biopsy, but I can say categorically, that today, if an NHS GP in London suspects cancer, you will have an appointment at a London hospital for a biopsy within two weeks. I'm 99% certain that this has been rolled out nationwide and is now the case for all levels of care, everywhere in the UK. If her case was recent and it really took three months from the GP making a diagnosis to getting seen at a hospital, you should lodge some serious complaints.

Finally, if you want to cut administration, paperwork and the bureaucracy, a total centralised allocation system is definitely not the answer. It is unworkable. I can't even envisage how it might work... you go to a GP, but before they can see you, they need to get money from a central pot, the amount of which is determined by the severity and complexity of the problem that can't be diagnosed until they can see you... which they can't do, because they can't get the money from the central pot until they know the severity and complexity of your problem...???

I'd be happy to discuss the idea further if you can flesh it out a bit?

Once more, I'd like to say I meant in no way to stir up bad blood!

My reaction was strong, I accept, but yours did wind me up something chronic. Thanks for the apology - it means a lot on such a sensitive subject. I too apologise for reacting so fiercely.

The cancer scare was some time ago. If it is now guaranteed 2 weeks that is a very welcome bit of news. No-one should have to wait in fear for 3 months.

Part of the problem with the drugs is the NHS system itself - where they cannot get it together or have no interest in actually investigating the problem, so just throw painkillers and antidrepressants at the problem and hope it goes away. As time goes on the problems get more severe and so more treatment and more drugs are required, and prozac, prescribed only so that you won't mind being on so many painkillers. The whole approach is wrong. So we have Gabapentin, Co-Codamol 100/30, topical anaesthetic plasters, beta blockers, prozac, liquid morphine and more. Imagine how much money the public could have been saved long term if more had been spent short term to properly diagnose and fix the problem in the first place. She is on a fraction of the drugs now, and we expect to reduce that even more.

I agree that there is a problem with drug prices - though I accept fully that the companies who have researched and developed those drugs with all that that costs should be able to reap the benefits of that effort and make a fair profit. Perhaps some kind of time limit on that exclusivity should be globally imposed - say 15 years or so, after which time the formulas must be made public domain - call it a fair price for having public money buy those drugs in the first 15 years.

Going private was a last resort, and was only made possible because it came with my current job. I too am glad it went well. And if people like me pay for the NHS but then don't use it because their job provides private health then there are more resources everyone else, so I'm not going to feel guilty about it.

you go to a GP, but before they can see you, they need to get money from a central pot, the amount of which is determined by the severity and complexity of the problem that can't be diagnosed until they can see you... which they can't do, because they can't get the money from the central pot until they know the severity and complexity of your problem...???

I think you're maybe too close - Your suggestion is way more complex than it needs to be. I don't see why you can't go to the doctor; the treatment that you need is provided, and the bill goes straight to the central pot. All a GP will do is diagnose conditions and refer or prescribe treatment. Complex conditions won't cost any more than simple ones for a GP - and as soon as a drug prescription is made the cost will be known to the central pot. Treatment providers would just bill the central pot rather than a multitude of local ones who then have to rebill. In short, whatever currently happens with many local authorites who then run out of cash could happen more easily with a single central one . anyway. just an idea

I agree that there is a problem with drug prices - though I accept fully that the companies who have researched and developed those drugs with all that that costs should be able to reap the benefits of that effort and make a fair profit. Perhaps some kind of time limit on that exclusivity should be globally imposed - say 15 years or so, after which time the formulas must be made public domain - call it a fair price for having public money buy those drugs in the first 15 years.

This already exists - generic drugs are ones that have gone off-patent and can be made by anyone. Big Pharma pushes drugs as strongly as possible (eg Pfizer's suggestion that women can benefit from Viagra too) while they are still protected by patent as this is when they make the bulk of their money, recoup their development costs and make a profit on top. Bear in mind that this is a relatively short space of time - they need to patent the drug before seeking FDA approval, which takes a long time - and the costs they need to recoup are unbelievably huge. That's why they market them so aggressively, particularly in the US.

The reason Big Pharma is struggling at the moment is because the "conceptual space" for small molecules is limited. Drugs need to treat a condition, be orally bioavailable (so you can take them in a pill) and have side effects that are less harmful than the condition they're treating. [If you're interested in this, Google "Lipinski's rule of five".] Most of the possible candidates have now been investigated. Barring major breakthroughs on the peptide front, Big Pharma will continue to suffer and will churn out fewer and fewer "blockbusters" each year.

But this misses the point. The real problem with privatised drug development isn't the cost for consumers in developed countries, it's the fact that these consumers are the only market. Drug companies got badly burned developing HIV treatments that they had to give away for peanuts in the developing world, after consumer / international pressure. All the money they spent developing and producing them was wasted. That's why you don't see any money going into HIV or Malaria treatments any more - it's recognised in the industry as a quick way to make a giant loss. Hence the focus on "lifestyle drugs" for conditions like insomnia, pain, erectile dysfunction, dementia, etc, and also the proliferation of "me too" drugs that are just there to compete and don't provide anything useful to clinicians when they're prescribing.

Instead, we need an international, socialised drug development program to treat these conditions. Hopefully as Big Pharma disintegrates we'll see this happen.

Thought I'd throw some additional links into the mix:

The NHS is the world's third largest employer.

A quick browse of the NHS Information Centre shows us that since that 2004 Times article, the NHS workforce has grown to match the combined populations of Liverpool, Manchester, Edinburgh and... Hereford.

The simple, simple reason for the lack of a 'central pot', is the sheer logistical impracticality of it.

You'd have to issue compulsory purchase orders for the whole of Manchester to fit all the NHS Administrators in one place. And if they needn't be in one place, then you'd have local departments. And if you have local departments, they might as well have local budgets, because it makes more sense if the Manchester office deals with Manchester drug requests as opposed to requests made in London.

Because if something goes wrong, and someone makes a complaint, holding a department in Manchester to account because of a mistake made somewhere along the line between the GP in Brighton, and the budgeting department in Manchester is going to be... difficult. A Bureaucratic Nightmare.

I don't see why you can't go to the doctor; the treatment that you need is provided, and the bill goes straight to the central pot. All a GP will do is diagnose conditions and refer or prescribe treatment.

It is a great idea. What it fails to factor in is the following:

• The cost of paying someone to be in at 7.30am to unlock the doors, switch off the alarms, switch on the lights, boot up the reception computers, turn on the message board and touch-screen check in machine, open the blinds, and let the patients in.

• The cost of paying the two other receptionists who turn up at 8.15am and log in to their computers, amd check in the patients as they arrive, or convey the message to Dr A that his 9:10am is running 10 minutes late.

• The cost of running the computer whilst writing that message, and the cost of the lights being on so the keyboard can be seen properly to do this.

• The cost of the locum doctor coming in for the morning clinic because one of the normal doctors is on holiday with the kids, and the cost of running her computer and lights all day.

• The cost of the surgical gloves she puts on before she touches the patient, and the single-shot tweezers she uses to remove a stitch, both of which she throws in the clinical waste bins immediately after the consultation finishes.

• The clinical waste bins.

• The people who remove the clinical waste bins for incineration

• The people who incinerate them.

• All of the lights and petrol used in this process.

• The special prescription paper the locum doctor is obliged to print the script on, and the ink used to print it. The USB cable that connects the printer to the computer that had to be replaced yesterday because it was faulty.

• The medical secretary who types the referral that the doctor dictates on the digital dictation device that I spent a few weeks researching.

• The salary I drew whilst conducting that research.

• The salary I drew whilst networking all the digital dictation devices.

• My salary in general, without which no referral could take place and no printer cable would have been replaced (for at least a few days!).

• The fax machine which we use to fax the referral to the Choose and Book people because it is urgent, or the ink and paper used to print out the transmission verification report.

And so on.

I stop because even I got bored of that... but we haven't got to the cleaners who are obliged to come every evening... the leaflets we are obliged to have on display... or the giant hospital with the same day to day minutiae to which we have just referred the patient.

It just is not as simple as patient comes, is treated, is referred, is prescribed drugs, is better.

You can't have a national, centralised budgeting departments for each of the above mentioned things, because no one would be able to hack a life of auditing clinical waste bin expenses. But when you scale up the number of such occurances throughout a workforce of 1.4million, serving a population of 60million, that is exactly what you'd need.

**Exactly the same thing for prescribed drugs and departments referred to. **Something like 3.5million women in the UK are prescribed the contraceptive pill. That is something like 9,500 requests a day, on average. You'd need a massive, dedicated staff to handle the sheer, unrelenting volume of them. And their entire lives would revolve around auditing contraceptive pill requests...

Why does it have to be so complex? Why is the paperwork so ingrained at every stage? You get this money from somewhere now. What's so different if you got it from somewhere else?
Why does everything have to be processed and audited by armies of civil servants? This stuff isn't so different from what every other company does without such a huge administrative headcount. What you are describing is the general expense of every office in the land. Nobody else finds it necessary to make it so complex. Why couldn't the electricity, gas and water bill direct to the Dept of Health, the waste incineration company bill direct to the dept of health or Salaries be billed direct to the dept of health. etc etc.

You seem to be saying that there is nothing wrong with the current system and it doesn't need to be fixed. But until a person in Bethnal Green can get the same drugs as someone in Cumbria, Shropshire, or Surrey then it does.