5 ms·

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government i

By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. By comparison to whatever the metrics of whatever government is in power at the time the NHS always looks terrible. Budgets can be set arbitrarily by the government so it’s easy to make the NHS look like it is over budget (in fact all you need to do is increase the budget by less than inflation and talk about absolute numbers to fool the public and hey presto “the NHS is terribly inefficient”). The whole “4 hour” thing is mad - you should be seen in a reasonable time frame for the ailment you have. Severed hand? Go right ahead. Headache and photo sensitivity that’s been going for a couple of days already? We’ll be with you when we can and if things get substantially worse come back to the reception and you may be deemed more critical. Obviously I am over simplifying the matter but the NHS is staffed by competent trained professionals who should be allowed to use their own judgment as the whether someone can wait 30 seconds, or 6 hours.

blibble 9y ago
> The whole “4 hour” thing is mad - you should be seen in a reasonable time frame for the ailment you have. Severed hand? Go right ahead. it's already like this, A&E is run on triage, "4 hours" is a target not an instruction and if you go to A&E with something like a cold you'll be given a stern talking to and sent home
- oldcynic 9y ago
  Here's some background on the pros and cons of clinical targets. They can distort priorities https://www.kingsfund.org.uk/projects/general-election-2010/performance-targets https://www.kingsfund.org.uk/projects/general-election-2010/...
- chrisseaton 9y ago
  > you'll be given a stern talking to and sent home Yes and then sometimes that person dies as the recent case in the news about the girl with asthma who was told off for being late and sent home to die. The NHS’s matronly they-know-better is a real problem of an effective state monopoly on healthcare. You can’t complain or take your business elsewhere. If they tell you to go home that’s it and there’s no other option.
  - cjrp 9y ago
    > If they tell you to go home that’s it and there’s no other option. Not even remotely true, if you don't mind paying. You can see a GP privately, there are already lots of apps which let you book appointments. A colleague had an ear problem, couldn't get an appointment with his local GP and so used one of these app-based services and got a same-day appointment with a doctor near the office.
    - chrisseaton 9y ago
      I think there’s only one private A&E in the UK. Most people wouldn’t be able to get to it. If you go private and something happens during treatment they have to put you in an ambulance and take you to an NHS A&E. For most ordinary people if the NHS tells you to go home that’s it you have to accept it. And people die because of this!
      - pjc50 9y ago
        Sure, and if the private system in the US tells you to home because you're not covered, you're just as stuffed. e.g. https://www.snopes.com/shane-patrick-boyle-died-after-starting-a-gofundme-campaign-for-insulin/ https://www.snopes.com/shane-patrick-boyle-died-after-starti... This is not to say that the NHS could not be better, but its problems would generally be made worse not better by introducing market or pseudo-market mechanisms. Unless universality can be guaranteed.
    - cjrp 9y ago
      Sorry, I was replying in relation to your example of the girl with asthma. She was turned away from her GP, not from an A&E.
  - pjc50 9y ago
    It's not true that there's no other option, there's a decent number of private hospitals and most major cities will have a private GP practice in too. Just like the American system, this is only useful for people who can pay for it.
  - 9y ago
jdietrich 9y ago
>By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. Ish. The NHS is remarkably cost-effective, but has relatively poor survival rates for cancer, stroke and myocardial infarction. International comparisons seem to damn the NHS with faint praise - it's cheap and the patients are happy, but it's not very good at keeping people alive. http://www.qualitywatch.org.uk/sites/files/qualitywatch/field/field_document/QW%20International%20comparisons%20%28final%29_disclaimer_update.pdf http://www.qualitywatch.org.uk/sites/files/qualitywatch/fiel...
- PoachedSausage 9y ago
  Having only quickly skimmed that document, I couldn't see anything about taking into account the effects of patient age. The NHS is facing massive demand by elderly patients who presumably have lower survival rates for various ailments. They should be going into nursing care, but that has not kept up with demand.
- cstross 9y ago
  A chunk of the poor cancer survival is down to cultural issues — British men in particular being socialized to not complain, so they don't go to their primary point of care until it's too late to do anything beyond palliative care. This is slowly changing, but it's generational. National-level screening initiatives also help: for example the Scottish NHS's national bowel cancer screening program. But when NHS England is facing real-terms cuts in spending, new long-term preventative stuff doesn't get rolled out.
- Marazan 9y ago
  Cancer survival rates are suprisingly tricky to measure. If I'm diagnosed with an incurable cancer 5 years before it kills me Vs diagnosed 3 months before hand then scenario 1 looks better in the cancer stats but scenario 2 is better for my peace of mind and probably avoid me having to have a bunch of superfluous medical procedures over the 5 years.
- PaulRobinson 9y ago
  Survival rates for all those things are affected by external factors that are not in the NHS' control. Smoking, drinking and obesity are all higher in the UK than in many other Western countries, and therefore the types and severity of these issues are likely incomparable. Compound this with the cultural differences of the NHS (you don't go for a six-month check-up unless you're elderly, you just see a doctor when you're already ill), and the fact spending has been prioritised towards other areas (particularly paediatrics), you start to see a different story. But there's also the fact the median age of the UK is relatively high. It's so good at keeping alive in younger years they get older and then develop cancer, stroke and heart disease/attacks later in life where they might be less survivable. We all have to die of something. The NHS can't prevent that. What it can do is stop you having a lot of those issues earlier in life as in other countries and therefore the quality of life is improved. If you want to see an area where it's proper shit, I would not start there: go with dental work, look at obesity prevention, etc. - that's where it's really lagging behind many other countries.

blibble 9y ago

> The whole “4 hour” thing is mad - you should be seen in a reasonable time frame for the ailment you have. Severed hand? Go right ahead. it's already like this, A&E is run on triage, "4 hours" is a target not an instruction and if you go to A&E with something like a cold you'll be given a stern talking to and sent home

oldcynic 9y ago
Here's some background on the pros and cons of clinical targets. They can distort priorities https://www.kingsfund.org.uk/projects/general-election-2010/performance-targets https://www.kingsfund.org.uk/projects/general-election-2010/...
chrisseaton 9y ago
> you'll be given a stern talking to and sent home Yes and then sometimes that person dies as the recent case in the news about the girl with asthma who was told off for being late and sent home to die. The NHS’s matronly they-know-better is a real problem of an effective state monopoly on healthcare. You can’t complain or take your business elsewhere. If they tell you to go home that’s it and there’s no other option.
- cjrp 9y ago
  > If they tell you to go home that’s it and there’s no other option. Not even remotely true, if you don't mind paying. You can see a GP privately, there are already lots of apps which let you book appointments. A colleague had an ear problem, couldn't get an appointment with his local GP and so used one of these app-based services and got a same-day appointment with a doctor near the office.
  - chrisseaton 9y ago
    I think there’s only one private A&E in the UK. Most people wouldn’t be able to get to it. If you go private and something happens during treatment they have to put you in an ambulance and take you to an NHS A&E. For most ordinary people if the NHS tells you to go home that’s it you have to accept it. And people die because of this!
    - pjc50 9y ago
      Sure, and if the private system in the US tells you to home because you're not covered, you're just as stuffed. e.g. https://www.snopes.com/shane-patrick-boyle-died-after-starting-a-gofundme-campaign-for-insulin/ https://www.snopes.com/shane-patrick-boyle-died-after-starti... This is not to say that the NHS could not be better, but its problems would generally be made worse not better by introducing market or pseudo-market mechanisms. Unless universality can be guaranteed.
  - cjrp 9y ago
    Sorry, I was replying in relation to your example of the girl with asthma. She was turned away from her GP, not from an A&E.
- pjc50 9y ago
  It's not true that there's no other option, there's a decent number of private hospitals and most major cities will have a private GP practice in too. Just like the American system, this is only useful for people who can pay for it.
- 9y ago

jdietrich 9y ago

>By comparative metrics to the rest of the world the NHS comes out either top or pretty damn good. Ish. The NHS is remarkably cost-effective, but has relatively poor survival rates for cancer, stroke and myocardial infarction. International comparisons seem to damn the NHS with faint praise - it's cheap and the patients are happy, but it's not very good at keeping people alive. http://www.qualitywatch.org.uk/sites/files/qualitywatch/field/field_document/QW%20International%20comparisons%20%28final%29_disclaimer_update.pdf http://www.qualitywatch.org.uk/sites/files/qualitywatch/fiel...

PoachedSausage 9y ago
Having only quickly skimmed that document, I couldn't see anything about taking into account the effects of patient age. The NHS is facing massive demand by elderly patients who presumably have lower survival rates for various ailments. They should be going into nursing care, but that has not kept up with demand.
cstross 9y ago
A chunk of the poor cancer survival is down to cultural issues — British men in particular being socialized to not complain, so they don't go to their primary point of care until it's too late to do anything beyond palliative care. This is slowly changing, but it's generational. National-level screening initiatives also help: for example the Scottish NHS's national bowel cancer screening program. But when NHS England is facing real-terms cuts in spending, new long-term preventative stuff doesn't get rolled out.
Marazan 9y ago
Cancer survival rates are suprisingly tricky to measure. If I'm diagnosed with an incurable cancer 5 years before it kills me Vs diagnosed 3 months before hand then scenario 1 looks better in the cancer stats but scenario 2 is better for my peace of mind and probably avoid me having to have a bunch of superfluous medical procedures over the 5 years.
PaulRobinson 9y ago
Survival rates for all those things are affected by external factors that are not in the NHS' control. Smoking, drinking and obesity are all higher in the UK than in many other Western countries, and therefore the types and severity of these issues are likely incomparable. Compound this with the cultural differences of the NHS (you don't go for a six-month check-up unless you're elderly, you just see a doctor when you're already ill), and the fact spending has been prioritised towards other areas (particularly paediatrics), you start to see a different story. But there's also the fact the median age of the UK is relatively high. It's so good at keeping alive in younger years they get older and then develop cancer, stroke and heart disease/attacks later in life where they might be less survivable. We all have to die of something. The NHS can't prevent that. What it can do is stop you having a lot of those issues earlier in life as in other countries and therefore the quality of life is improved. If you want to see an area where it's proper shit, I would not start there: go with dental work, look at obesity prevention, etc. - that's where it's really lagging behind many other countries.