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.