Distressed.
By Scott W Atlas, MD
Britain’s National Health Service (NHS) turns 65 years old this week.
It is no small irony that the United States simultaneously celebrates
its independence from Great Britain. Emotionally feted by UK citizens
and political leaders, the NHS is typically celebrated as a magnificent
badge of honor and even as a symbol of national identity in Britain.
In its most recent portrayal to the world, the NHS was featured at
the opening of London’s 2012 Olympic Games in a spectacular display with
dancing nurses, delighted children, and other fantasy-based imagery.
Before the ceremony, Danny Boyle, the ceremony’s creator, declared that
he chose to showcase the NHS because “everyone is aware of how important
the NHS is to everybody in this country” and that “one of the core
values of our (British) society is that it doesn’t matter who you are,
you will get treated the same in terms of health care.”
2012 Olympics Opening Ceremony...kneel before 'God' even if you have been waiting for those 'elective' knee replacement surgeries for more than a year
Despite its much heralded presence in Britain’s health care, the
problems of the NHS are severe, notorious, and increasingly scandalous
in the most fundamental attributes of any health care system: access and
quality.
Waits for care are shocking in the NHS, frequently exposed by British
media reports, and long proven by facts, yet they go virtually
unreported in the U.S. For instance, in 2010, about one-third of
England’s NHS patients deemed ill enough by their GP waited more than
one additional month for a specialist appointment. In 2008-2009, the
average wait for CABG (coronary artery bypass) in the UK was 57 days.
And the impact of this delayed access was obvious. For example, twice as
many bypass procedures and four times as many angioplasties are
performed in patients needing surgery for heart disease per capita in
the U.S. as in the UK. Another study showed that more UK residents die
(per capita) than Americans from heart attack despite the far higher
burden of risk factors in Americans for these fatal events. In fact, the
heart disease mortality rate in England was 36 percent higher than that
in the U.S.
Even if your mum is having a heart attack, do NOT attempt to talk to duty nurses when they are on rounds. They do NOT have to speak to you...and, frequently, will tell you so!
Access to medical care is so poor in the NHS that the government was
compelled to issue England’s 2010 “NHS Constitution” in which it was
declared that no patient should wait beyond 18 weeks for treatment –
four months – after GP referral. Defined as acceptable by bureaucrats
who set them, such targets propagate the illusion of meeting quality
standards despite seriously endangering their citizens, all of whom
share an equally poor access to health care. Even given this
extraordinarily long leash, the number of patients not being treated
within that time soared by 43% to almost 30,000 last January. BBC
subsequently discovered that many patients initially assessed as needing
surgery were later re-categorized by the hospital so that they could be
removed from waiting lists to distort the already unconscionable
delays. Royal College of Surgeons President Norman Williams, calling
this “outrageous,” charged that hospitals are cutting their waiting
lists by artificially raising thresholds.
Beyond access, the quality of medical care in the NHS, based on data
in the medical journals, is unacceptable. Comparing data for cancer,
heart disease, and stroke, the most common sources of sickness and death
in the U.S. and Europe, and the diseases that generate the highest
medical expenditures, we see the overt failure of the NHS and its
socialist relatives.
Some of the 400 ( to 1,200) patients that the Mid-Staffordshire Trust and Stafford Hospital left to 'unnecessarily' die while in care in a 3 year period
For cancer, American patients, both men and women, have superior
survival rates for all major types. For some specifics, per Verdecchia
in Lancet Oncology, the breast cancer mortality rate is 88
percent higher in the United Kingdom than in the U.S.; prostate cancer
mortality rates are strikingly worse in the UK than in the U.S.;
mortality rate for colorectal cancer among British men and women is
about 40 percent higher than in the U.S.
Even given the lifestyle-related disadvantages inherent to American
patients (physically inactive, obese, and with high blood pressure –
all significantly higher than comparison countries), studies also prove
better medical care for stroke in the U.S. than in Britain. In 2010, the
British scientific journal Lancet Neurology stated in its
editorial about stroke treatment entitled “Time is Brain for Carotid
Endarterectomy” that “early intervention is crucial for a good outcome,”
yet “two- thirds of patients (in the UK) face an unacceptable delay.”
To assess the quality of care for high blood pressure, or
hypertension, we must look at two sets of data. First, once hypertension
is diagnosed, is it treated or does it go untreated? About two-thirds
to three-fourths of patients with high blood pressure in England were
left untreated, compared to less than half in the U.S. Second,
hypertension treatment in the UK has been inferior and less successful
in controlling blood pressure than the U.S. One comparison showed that
blood pressure control was best in the U.S., outperforming Canada,
England, Germany, Italy, Sweden, and Spain. In a separate analysis of
over 21,000 patients already visiting doctors for hypertension, the best
rate of success was in the U.S. (63 percent), compared with 31 percent
to 46 percent of patients in England and the European countries.
No disease has more far-reaching and more serious consequences than
diabetes, with a risk for death about twice that without diabetes, and
significantly worse disease outcomes. In 2011, the World Health
Organization determined that of seven countries including England and
Scotland, the U.S. had the highest proportion of adult diabetics who
were actually receiving treatment for their known diabetes, as well as
for their hypertension and high cholesterol. The U.S. also performed
best by several different quality measures, approximately twice the
success of England and Scotland.
Add to those illustrious facts the heinous scandals about the quality
of care in NHS hospitals that are repeatedly discovered, investigated,
and catalogued with promises of change. These scandals, like the
Staffordshire Trust debacle where between 400 and 1,200 neglected and
abused patients died in squalid and degrading circumstances, are
directly caused by the very culture of the NHS, as overtly admitted even
by the UK government at its highest levels.
Although under the radar here in the U.S., the 2013 Staffordshire
report issued by the public inquiry that began in 2010, containing more
than one million pages and 64,000 documents, and costing British
taxpayers about $20 million, Chairman Robert Francis made 290
recommendations. Above all, the report noted the insidious negative
culture involving a tolerance of poor standards, a focus of working for
the system and its bureaucratic measurements rather than for patients,
and a lack of accountability to the patients who ultimately pay
considerably for the services. Even though Health Secretary Jeremy Hunt
said the report marked the start of a “fundamental change to the
system,” the majority of recommendations simply add more regulation and
more power to GP’s instead of more patient choice.
Oh, wait. You actually thought that you'd have even a semi-private room?
Reality also prevents accepting the fantasy that the NHS-style socialized medicine as initiated in 1948 has actually lived up to the so-called “core value” of British society. For if true, it must seem odd that people of means in Britain consistently look elsewhere for medical care. About six million Brits now buy private health insurance, including almost two-thirds of Brits earning more than $78,700. According to The Telegraph, the number of people paying for their own private care is up 20 percent year-to-year, with about 250,000 now choosing to pay for private treatment out-of-pocket each year. And does anyone wonder why Prince Philip recently chose to receive his medical care in the private London Clinic? Is it a mystery why Prince William and Kate Middleton have chosen to deliver their royal baby and receive birth care at the private St. Mary’s Hospital? Isn’t it notable that more than 50,000 Britons travel out of the country per year and spend £161 million to receive medical care due to lack of access, even though they are hemorrhaging money for their national pride? When given the choice, Brits shun the NHS, and rightfully so.
Sadly, just as in America, many in the media attempt to spin the
facts and control public opinion. As yet another crisis is revealed at
an NHS hospital in Greater Manchester that is so chaotic that patients
are being left in pain, wait up to four days to even see a doctor,
embarrassingly apologetic statements by the UK media try to rationalize
the disgraceful system and assert, albeit lamely, the NHS’s supposed
virtues, such as “In the resulting 65 years it has, like any huge public
body, been guilty of incompetence, cover-up and cavalier disregard of
its patients” (Scotland’s The Herald, July 1, 2013). Even the
hard-hitting 2013 Staffordshire report still insisted near the top of
its list of summary points that “the NHS is a service of which the
country can be justly proud, offering as it does universal access to
free medical care, often of the highest order.” All of these statements,
even though the UK government itself needs to issue report after report
designing extraordinarily weak objectives for patient wait times and
restating what should be inherently obvious goals, such as “We will put
patients at the heart of the NHS” (Department of Health, 2010, Equity
and excellence: Liberating the NHS, p.5).
Beyond even the shameful quality of care and the shockingly long
waits for specialist appointments, essential tests, and life-saving
treatments, perhaps the greatest deception of all is the continued
reference to “free” health care for British citizens. The cost to
patients and taxpayers is enormous. In the face of a 2014 NHS budget of
£114 billion ($175 billion), Secretary of State for Health Jeremy Hunt
has audaciously argued for no cuts, even though NHS spending has
increased by 94 per cent in real terms between 1999-2000 and 2009-2010
with its appalling results and lack of accountability, according to the
June 2013 report from British think tank Reform.
Instead of repeatedly waxing that the NHS and its socialized medicine
comprise a “national religion,” it might be better to acknowledge the
essence of medical care – preventing, diagnosing, and treating disease
for patients, not setting up a massive government bureaucracy. Even the
Prime Minister’s 2010 white paper admitted that “the NHS is admired for
the equity in access to healthcare it achieves” but not for excellence –
as if equally poor access is an achievement. Even though the UK’s
mandatory retirement age at 65 was officially eliminated in 2011,
perhaps the greatest gift of all to the Brits, and a true celebration of
independence, would be to forcibly retire their falsely venerated NHS.
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