Diary of an NHS Patient – 2017

2nd January 2017
New year, new diary! Just moved to our forever-family home. Nice area, good primary just round the corner for Charlie and we are only twenty minutes from Dave’s work. Only issue is they just ‘downgraded’ our local A&E– but I’m not worried, although Dave thinks I’m a hypochondriac! GP is local and there’s a big hospital a short drive away. Anyway, back to unpacking!

3rd March 2017
Finally got round to signing us all up at the GP- it’s such a faff. They wanted to see all our passports, and could only sign us up between 1-2pm on Wednesday. Who can manage that? Charlie had a cough for a few weeks so that finally pushed us to join. Waiting time bit long though- two weeks! Oh well. He’s fine.

10th April 2017
Still haven’t got an appointment for the GP! Charlie is looking a bit peaky- it’s been too long now. Phoned up for emergency appointments but the GP never has a free slot. I heard from Linda next door they might have to close- can’t maintain the practice on the funding they’ve got. Never mind. Plenty of other NHS GPs around. Even had a leaflet for a private GP through the door today- £40 an appointment. Bit steep. But booked one anyway. Dave didn’t mind.

17th April 2017
The private GP seemed very nice- referred Charlie for lots of tests though. Dave is worried- he thinks it’s a scam. I don’t. I saw the GPs face- he thinks Charlie is really sick. He asked us if we wanted to stay with the NHS- is that really a thing now? I don’t think we can afford any more private tests. He’s sending us to our local NHS children’s department.

24th May 2017
Waiting for an appointment is agonising. Lost our nerve tonight when Dave thought Charlie coughed up some blood. Everyone was a bit flustered so we went to local children’s A&E- except it was closed. Lack of staff. What the hell does that mean? I’ve never heard of a hospital being ‘closed’. What do we pay our taxes for if not the NHS? We got redirected to another hospital, had a minor divorce-level fight outside the A&E and then decided just to take Charlie home. Our appointment is next week anyway.

1st June 2017
Charlie has cystic fibrosis. I’ve spent hundreds of hours looking all over the Internet and everywhere about it. The specialist at the hospital was very nice- but we were still all in tears. We have another appointment next week. It’s still settling in- my child will always be unwell. I don’t know how to handle this. We tried to see the NHS GP this week- just to touch base. They’ve closed for good. I went back to the private GP for an appointment- looked a lot busier. Had to wait a few days this time. Saw a different GP for £50 this time. Wasn’t very helpful. What a waste of money.

10th Oct 2017
Charlie is managing on his inhalers and things. The NHS department at hospital is great- we have the mobile of Sandra, the nurse specialist for Charlie and any problems just call her up. Heard some mutterings about closing the hospital, ‘centralising’ services. Sounds like a good idea, but Sandra reckons many services like theirs will be cut in the reshuffle. Off the record she said the hospital might close entirely. I left pretty frightened, imagining losing such a lifeline for us. Wrote to my MP when I got back. Why are all the NHS services shutting down?

2nd Dec 2017
Sandra called- they are being moved to another hospital, and their service halved. More ‘efficiency savings‘. She’s not covering anymore- it’ll be a duty nurse system now. I did the maths- our local specialist children’s hospital is now forty miles away. Just shy of 45 minutes by car. What we will do in an emergency? Dave is starting to get chest pains when he’s carrying Charlie up the stairs. We can’t afford to go back to the local private GP right now, the next closest NHS GP isn’t accepting new patients. Just ignoring it now, and hoping.

5th Jan 2018
More leaflets through the door- private health insurance companies offering discounts. Our local NHS hospital has just been taken over by a private firm. Me and Dave had a huge row, and then decided to look into private health insurance. We both believed in the NHS, but it’s clear that it’s not going to survive unless the government step in.  Plus Dave is self-employed and so am I- might be a bit trickier. We will struggle through.

20th March 2018
Got insured with Health Co. – few others in the street did the same. Quite steep for me and Dave – lots of cancer stuff on both sides of our family, plus we both run our own businesses. Dave went to  an appointment on the very next day- Health Co. GP sent him straight to the heart doctor at the private hospital. Long story short- Dave needs a stent in his heart- not a heart attack, but pretty close according to the doctors. Thank god we got the insurance when we did. Charlie has been good.

1st April 2018
Dave had his heart op today- says he’s feeling much better. Stayed in a nice room in the Health Co. ward- had to pay an excess though, £500. A lot more than we could afford. Really weird feeling as a 1970s child having to worry about money and healthcare in the UK. Anyway- no worries. Everyone’s at home and everyone’s well.

9th April 2018
Health Co. sent us a huge bill today. They say Dave isn’t covered for his op, because he had pre-existing symptoms. Altogether they want nearly £9,000. We were aghast. We tried contacting the NHS hospital to see if they would cover us – we still pay taxes. An hour of ringing got me to a stressed sounding secretary who just laughed in my face. We tried to move back to cardiology at our local NHS hospital- but they don’t do outpatients anymore. Have to raid the savings, probably add a bit to the mortgage too. Need to get the hang of this insurance business better.

15th June 2018
Charlie is sick again – looks like his cystic fibrosis. Went to a great Health Co. GP who wanted to send us to the Health Co. hospital. The hospital wanted to know is Charlie insured. We thought he was- – the hospital says not. An hour of furious tears on the phone turns out they are right- he was excluded because of his cystic fibrosis from a regular family policy. We could pay out of pocket, but the nice Health Co. GP said that might costs hundreds of thousands of pounds. We’d have to sell our house. So I called Sandra- she told us to drive to her NHS hospital, even though it’s an hour and half away. I never expected to be choosing between  money or my family’s health. How did this happen? Anyway, we drove to the ‘central’ children’s hospital – and they rushed Charlie to their high-dependency bay. He’s stable now. Dave and I can’t seem to talk to each other, every conversation turns into blaming the other for the insurance rubbish. Bad night for everyone.

17th June 2018
The NHS has really changed- much of the hospital is actually just private companies that have taken over different sections. I’m signing all sorts of documents about insurance and waivers and declining ‘optional’ extras. Whole wards of the NHS buildings are empty. It’s scary.  The NHS staff haven’t changed though- Charlie’s paediatric team are the same amazing, hard-working angels they’ve always been. Sandra has been in every day- she looks awful. I’ve never seen her so stressed. I caught her for five minutes to catch up and thank her- I asked her how’s work- and she started crying. Most of her colleagues have left the NHS side, she’s the last cystic fibrosis nurse left in the county for the ‘uninsured’. She gets heartbreaking phone calls like mine every five minutes. She has to turn many of them down. She can’t cope. Every month they get less funding and are told to be more ‘efficient’. She’s close to retirement she told me, so she said she was determined “to see it out”. Her career? I asked. No, she said, “the NHS”.

21st Aug 2018
Charlie is back at home. We did two months driving an hour and a half a day to be with him. We took it in shifts, so Dave and I haven’t really been in the same room for more than twenty minutes for 8 weeks. Our relationship is struggling, but at least Charlie is better. I managed to get him back on a Health Co. policy- but the costs are phenomenal. We had thought about a second baby, and if my business had done better maybe even a third. Now we will settle for Charlie. Health Co. gave us a card to show private ambulances to get to our local hospital. Our GP is private, all of Dave’s cardiology appointments are now private, at huge cost, but at least we are covered.

10th Jan 2019
Dave’s mum had a stroke. She’s 92 and the first we heard about it was a call from a care home telling us she can’t pay. We were shocked. She’d been sent to a ‘central‘ elderly care ward fifty miles away, and then sent back to a care home near Dave’s brother. Obviously Dave’s mum was still on the NHS. Apparently there is supposed to be free coverage for the elderly, but it doesn’t cover care costs. We went to the care home- it seemed nice enough. It’s all private though- the manager was a lovely man, who explained we basically had two options; sell Dave’s mum’s house, the house he grew up in, or move her to the NHS subsidised home a few towns away. We went to the NHS one- bit shocked by how run down it looked. Social care apparently has been cut just as hard as the NHS was– it’s all basically private now unless you can’t afford it. We are selling Dave’s mums house.

3rd May 2019
I found a breast lump today, in the shower. It felt like a hard rubbery knot, just under my right breast. Scared and anxious the first thing I did, still in my towel, was go to the Health Co. policy documents in my office. I read them three times over- trying not to linger on the ‘C’ word, but also making damn sure that if I go to the doctor now, we won’t lose our house. Only when I was sure did I go tell Dave. I felt sick watching his face as he felt it too. We booked into a private GP appointment- have to wait a week now, and still have to pay £60 excess.

30th May 2019
Had all our scans, tests, appointments, re-appointments. It’s a low grade breast cancer. Hasn’t spread- it’s an operation, then chemotherapy for a few years, then done. Sort of relieved, sort of mind-bogglingly terrified. All private staff, all the way through. Dave and Charlie have been very supportive. Hasn’t cost too much in excess payments etc. No holiday this year but let’s get some perspective. Op will be next week.

12th June 2019
Op went well, back at home on tablet chemotherapy. The doctor offered me radiotherapy as well- I thought that was a good idea. Booked in next week.

3rd August 2019
A bill arrived today. Another bill. I can’t cope with this. It’s for some aspects of my cancer treatment- apparently the company made an ‘error’, a lot of treatment was ‘extra-contractual’, bottom line; they won’t pay for it now. The CT scan that gave me the all-clear was ‘extra’, the radiotherapy treatment was ‘extra’, all of the nights in hospital with side effects were ‘extra’. The ‘extra’ cost is £192,000.
I keep looking at that number, wondering how it ever came to this.
My mum had cancer- she had a thyroid lump ten years ago. I went to all her appointments, in and out of NHS hospitals, specialists, scans, surgeons. She’s fine. And she never once paid a penny more than her taxes. What a different world we live in now.

5th November 2019
If I sell my stake in my accounting firm, Dave sells his business and goes back as an employee, and we sell our house and downsize we can just about make the payments without declaring bankruptcy. Charlie’s insurance is gonna hit us hard though.
I saw Sandra in the paper today- I spotted her face protesting in a crowd outside her NHS hospital. Shut down, no funds and not enough staff they say. I text her. She’s retiring now. She’s seen it out, and for her the NHS is over.
For the rest of us as well it seems.

3rd Jan 2020
I did some research. We were all told private companies came to ‘save’ the NHS, that healthcare was no longer ‘affordable’.
But compared to our neighbours the NHS didn’t cost very much- just under 8% of GDP in 2015, well below what Germany and France were spending. We were told that more money was being given to the NHS, but it never really was. Compared with demand the last ever decade of the NHS was also it’s most austere. 
Now we can just get by without the NHS- but only just, and we were fairly well off. I worry for those that aren’t. Every day I worry about the next treatment for Charlie or what if my cancer comes back? How will we afford the co-payments and excess charges?
Now the NHS is still around, but it’s gone in all but name. It’s for emergencies and the unemployed and poor only. Basic healthcare. I don’t pay any less tax- more money goes on my family’s hospital bills than ever before.

1st July 2020
A new government is about to be elected. I’m going to campaign hard for the NHS to return. Too many of us are suffering its loss. But no mainstream party has a realistic plan to restore it. It’s simply too late.

I’d wish I’d done something when I had the chance.

Juniordoctorblog.com

Happy Birthday: The National Health Service

You might not know this, but it is the NHS’s birthday today. It will be the tender age of 66-years young, born on the 5th July 1948. For those of you thinking of cracking jokes about ‘retirement’ age, please don’t. At the time, The Guardian hailed it’s creation “not as an achievement, but an opportunity”[1]. I wonder what they might have meant by that, and what they might make of the NHS today? Reading through the comments from last week found some old myths about the NHS resurfacing. I thought it might be worth looking a bit closer at a few of the common ones, with a bit closer eye than the standard Daily Mail monocle.

Myth #1

The NHS is already too expensive

Here is how much the UK spends on healthcare (both private and public expenditure): 9.4% of it’s GDP annually in 2012. Which is equivalent to $3647 or £2126 (at the time of writing) per person per year, or £177/ month. 82.5% of that is public money, i.e the NHS.

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?order=wbapi_data_value_2012+wbapi_data_value+wbapi_data_value-last&sort=desc

Here is how much the US spends on healthcare: 17.9% of it’s GDP annually in 2012. Which is equivalent to $8895 or £5195 per person per year, or £432/month. 2.44 times as much as we do. 46.2% of that is public money, and 53.8% is paid through private insurance companies or directly out-of-pocket.

In fact, in 2012, the UK was ranked 29th on the list of countries spending their % GDP on healthcare, a list that has not only Canada, New Zealand and the US ahead of us, but also the Marshall Islands, Serbia and Moldova.

The bottom line: We don’t spend very much on healthcare compared to the rest of the world.

Myth #2

The NHS is rubbish

As above, 82.5% of all money spent of healthcare in the UK is public, mostly NHS money. It’s very hard to extract how good a job any healthcare system does, especially between countries where the populations and local factors are so varied. But here are the stats.

These are the all-cause mortality figures for the UK from 2012/3;

Maternal mortality ratio: 8 deaths per 100,000 live births (Joint 8th in the world)
Mortality rate per infant 4 deaths per 1,000 births (Joint 4th in the world)

Life-expectancy at birth: 82 (Joint 2nd in the world)

These are the same figures from the US from 2012/3;

US:
Maternal mortality ratio: 28 deaths per 100,000 live births
Mortality rate per infant: 6 deaths per 1,000 births
Life-expectancy at birth: 79

Bottom line: The vast majority of healthcare in this country is NHS-led and, despite spending less than half as much as our American cousins, has much better outcomes for pregnant women and marginally better outcomes for children and a longer life expectancy, by three whole years.

http://data.worldbank.org/indicator/SP.DYN.LE00.IN/countries

Myth #3

Private care is better than NHS care

I looked very hard for some proper, rigorous, scientific trial looking at this but it isn’t out there as far as I can see. But, as pointed out above, in a country (the US) where 54% of the healthcare is private, health outcomes are poorer than in a country where 85% of the healthcare is publicly provided.

If you take the amount above as everyone paying for his equally- your NHS care costs £177/month. For that, you are covered for nearly any serious health condition, unlimited GP attendances, hospital stays, surgeries, imaging, lab tests- the lot. That’s not to say there are few things not covered by the NHS- but you’d be hard pressed to find them on private health plans. In fact, hunting around on private healthcare websites, I struggled to find any plan that could provide a similar service to the NHS- and remember these plans often include NHS services such as hospitals, radiology departments and staff members, plus you still have to pay your taxes.

On an anecdotal level, people’s perception of private healthcare is wildly different from the view of healthcare professionals. If you are having a minor op, a knee replacement or hip replacement, by all means, you will enjoy the private side room, the better food, the quicker scans and appointments and physiotherapy. But, although it doesn’t seem like it to you, to any doctor you are relatively well.**

When you are really sick, when you need to go to intensive care, or are in a car accident, or have a life-threatening heart attack, seizure or head injury, you do not want to go ‘private’. You won’t want better food or satellite television and you especially do not want to be shut away in a side room- those are times when those commodities are dangerous. You want the same attention from teams of healthcare professionals that Joe Bloggs gets- because they deal with conditions like yours on a daily basis, and no one will ask you to mortgage your house to pay for it.

Myth #4

The NHS is failing

In 2010, according to the Kings Fund British Social Attitudes survey, public overall NHS satisfaction was 70%- an all-time high.

In 2013, despite a record fall, public satisfaction with the NHS was up to 63%, the third highest since records began in 1983.

http://www.kingsfund.org.uk/press/press-releases/public-satisfaction-nhs-stabilises-after-record-fall.

Over that same period NHS hospital workloads increased by 5.3%, treating 17.7 million patients in 2012/13.***

The bottom line: Despite year-on-year cuts in budgets, tremendous pressures on A&E, and a 5.3% increase in the workload of the NHS, satisfaction is still high.

In the meantime the government passed the Health and Social Care Act, of which reforms cost the UK taxpayer somewhere between £1.6 billion and £3 billion. The equivalent of 100,000 years of pay for a junior doctor, 100,000 free university places, 2 or 3 brand new hospitals or several round trips to the Moon. I honestly don’t know if this has had any beneficial impact to the patient in front of me, and I’d love to hear from any healthcare professional who does.

For me, the NHS, as it is for so many of it’s 1.7million employees, is more of an old friend. I love it and hate it, loathe it and admire it in a entirely different way to the people who come in and out for such a short time of their lives. For them it’s either the place that saved a loved one, or maimed them. I am honestly not in ‘support’ of the NHS or ‘against’ it. As ever, the real discussion is much more complicated. But please, be fair to it. It is it’s birthday today.

Juniordoctorblog.wordpress.com

*If you live in a country with a similar national institution that conjures such personal and idiosyncratic arguments as the NHS please let me know.

** And more than likely, although you won’t know it as you write your cheque to BUPA, you were seen by a consultant who works in the NHS, in an NHS hospital with an NHS operating theatre staff, anaesthetist and, especially, NHS junior doctors. For those of you not in the know, trainee junior doctors are not allowed to work privately, so any you see in an NHS environment are more than likely looking after you entirely for free. If you can point to any other organisation that would do that, I will eat my stethoscope.

***2009-10 there were 16,806,196 ‘finished consultant episodes’, which more or less means number of individual episodes of illness in NHS hospitals. In 2012-13 this increased to 17.7 million. http://www.hscic.gov.uk/searchcatalogue?productid=13264&q=title%3a%22Hospital+Episode+Statistics%2c+Admitted+patient+care+-+England%22&sort=Relevance&size=10&page=1#top

[1] http://www.theguardian.com/theguardian/2013/jul/05/nhs-national-health-service-beveridge-labour