3 ms·

It's a shame that (from my perspective anyway) a lot of that state capacity seems to have degassed for the NHS. Right now it's impossible to get a doctor's appo

by veltas 3y ago

It's a shame that (from my perspective anyway) a lot of that state capacity seems to have degassed for the NHS. Right now it's impossible to get a doctor's appointment where I live. If you call any local surgery within a split second of 8:00am then you have a very low chance of getting an appointment, every time I've tried the line's busy or I'm number 60 in the queue and after a 40 minute wait all the appointments are gone. They are also fully booked for advance appointments every day (they limit the time in advance you can book, probably to prevent having e.g. a 2 year wait time on appointments, because it 'looks better' if nobody can go than if there's literally a 2 year advance appointment wait). The only way to see a doctor is to go to A&E, or convince NHS 111 to give you an "emergency appointment" of some kind. All of this drains emergency resources and are not an option due to the time investment for average people with precarious employment. Unfortunately many people won't believe these facts, because depending on which area you live in there's always plentiful appointments, in advance or on the day! Where I last lived, getting an appointment was easy, the difference in outcomes based on how wealthy or urban your area is leaves a bad taste in my mouth. Briefly, we had a new surgery open that offered more appointments, at more convenient times of day, and we could actually see the doctor. All the other GP's started losing their patients to them. Then within a few months they were shut down by the local NHS trust, under multiple investigations (one of these investigations was regarding an offensive Facebook post by the surgery's chief, I kid you not). They then later reopened with normal appointment times and no free spaces, like all the other surgeries. I agree with what you say re the command economy of WW2 allowing the creation of the NHS. But it was not this country that founded the NHS: it is some ancient, lost nation that seems utterly alien to me today. I don't believe we could achieve even a small version of what WW2 Britain did anymore, if our survival depended on it. I cite the UK's response to COVID19 as evidence.

Scarblac 3y ago
Same as in the US -- right wing politicians who believe the state is bad at doing things remove the funding that allowed the state to do it. Then when that means those government provided services become worse, they use that to show that the state is bad at doing those things, and therefore even less funding should go there, et cetera.
ctippett 3y ago
This mirrors my exact experience with the NHS – the futile 8am phone calls, to relying on NHS 111 for any hope at getting medical attention. Coming from Australia and previously NZ, the healthcare system here seems barbaric.
- robocat 3y ago
  New Zealand isn’t much better - last time I tried to book a doctor, they said they had n appointment free at the end of the month. Meanwhile, if you actually need to go to the doctor for anything urgent, it is often best to go direct to A&E.
jodrellblank 3y ago
> "I cite the UK's response to COVID19 as evidence." Here's some things I would love to see an alternate-history version of: 1) Vitamin D has some involvement in the immune system. The US Department of Health[1] says "Your immune system needs vitamin D to fight off invading bacteria and viruses.". Harvard School of Publich Health says[2] "laboratory studies show that vitamin D can reduce cancer cell growth, help control infections and reduce inflammation", "a large meta-analysis of individual participant data indicated that daily or weekly vitamin D supplementation lowers risk of acute respiratory infections" 2) The UK NHS page on Vitamin D does not mention immune function at all[3] but does strongly imply that everyone in the UK is deficient during winter when it recommends "since it's difficult for people to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter." 3) The Harvard page linked earlier says a randomized controlled trial with 340 Japanese school children given either Vitamin D or a placebo, the Vitamin D group had 40% fewer flu infections in winter. What do we know about COVID? It's an infection, it's expected to be more prominent in winter, some of the knock-on effects are to do with inflammation of tissues all around the body - lung, heart, brain, nerves. So, would anything have played out differently if during the early days of no vaccines and no effective treatment, the NHS had leaned hard into Vitamin D testing and supplementation? Anyone presenting to a doctor or hospital or care home of any kind for any medical problem gets a routine blood test for VitD levels as well, any blood tests happening for anything also test for VitD levels, high risk people picked out specifically and called for testing, generic supplments freely available from GPs and pharmacies even without prescription using the NHS's large scale buying and negotiating power, anyone found deficient given a strong dose or large injection to start with, public relations push for the public to supplement or get checked, kept up all through the year leading into the first winter. Would it have made a difference to the ease of it spreading, to the amount of dead people, to the amount of hospitalized people, to the amount of long-term complications, would it have flattened the curve, helped the NHS, reduced or eliminated the lockdowns? I am indoors most of the time, but I eat a lot of the recommended vitamin D foods - dairy, eggs, red meat, sardine, mackerel - and still had 'severely deficient' levels the first time I paid for my own test out of my own curiosity[4], and then 'insufficient' the next time. That seems like the kind of thing a "national health service" would be well placed and incentivised to do, whereas a for-profit expensive-pills-and-surgery-and-insurance-profit "service" isn't. [1] https://ods.od.nih.gov/factsheets/VitaminD-Consumer/ https://ods.od.nih.gov/factsheets/VitaminD-Consumer/ [2] https://www.hsph.harvard.edu/nutritionsource/vitamin-d/ https://www.hsph.harvard.edu/nutritionsource/vitamin-d/ (click to expand the 'immune function' section) [3] https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-... [4] (by a UK NHS lab, one which doesn't sell supplements so it's not incentivised to report misleadingly low figures)

by veltas 3y ago

Scarblac 3y ago

Same as in the US -- right wing politicians who believe the state is bad at doing things remove the funding that allowed the state to do it. Then when that means those government provided services become worse, they use that to show that the state is bad at doing those things, and therefore even less funding should go there, et cetera.

ctippett 3y ago

This mirrors my exact experience with the NHS – the futile 8am phone calls, to relying on NHS 111 for any hope at getting medical attention. Coming from Australia and previously NZ, the healthcare system here seems barbaric.

robocat 3y ago
New Zealand isn’t much better - last time I tried to book a doctor, they said they had n appointment free at the end of the month. Meanwhile, if you actually need to go to the doctor for anything urgent, it is often best to go direct to A&E.

jodrellblank 3y ago

> "I cite the UK's response to COVID19 as evidence." Here's some things I would love to see an alternate-history version of: 1) Vitamin D has some involvement in the immune system. The US Department of Health[1] says "Your immune system needs vitamin D to fight off invading bacteria and viruses.". Harvard School of Publich Health says[2] "laboratory studies show that vitamin D can reduce cancer cell growth, help control infections and reduce inflammation", "a large meta-analysis of individual participant data indicated that daily or weekly vitamin D supplementation lowers risk of acute respiratory infections" 2) The UK NHS page on Vitamin D does not mention immune function at all[3] but does strongly imply that everyone in the UK is deficient during winter when it recommends "since it's difficult for people to get enough vitamin D from food alone, everyone (including pregnant and breastfeeding women) should consider taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter." 3) The Harvard page linked earlier says a randomized controlled trial with 340 Japanese school children given either Vitamin D or a placebo, the Vitamin D group had 40% fewer flu infections in winter. What do we know about COVID? It's an infection, it's expected to be more prominent in winter, some of the knock-on effects are to do with inflammation of tissues all around the body - lung, heart, brain, nerves. So, would anything have played out differently if during the early days of no vaccines and no effective treatment, the NHS had leaned hard into Vitamin D testing and supplementation? Anyone presenting to a doctor or hospital or care home of any kind for any medical problem gets a routine blood test for VitD levels as well, any blood tests happening for anything also test for VitD levels, high risk people picked out specifically and called for testing, generic supplments freely available from GPs and pharmacies even without prescription using the NHS's large scale buying and negotiating power, anyone found deficient given a strong dose or large injection to start with, public relations push for the public to supplement or get checked, kept up all through the year leading into the first winter. Would it have made a difference to the ease of it spreading, to the amount of dead people, to the amount of hospitalized people, to the amount of long-term complications, would it have flattened the curve, helped the NHS, reduced or eliminated the lockdowns? I am indoors most of the time, but I eat a lot of the recommended vitamin D foods - dairy, eggs, red meat, sardine, mackerel - and still had 'severely deficient' levels the first time I paid for my own test out of my own curiosity[4], and then 'insufficient' the next time. That seems like the kind of thing a "national health service" would be well placed and incentivised to do, whereas a for-profit expensive-pills-and-surgery-and-insurance-profit "service" isn't. [1] https://ods.od.nih.gov/factsheets/VitaminD-Consumer/ https://ods.od.nih.gov/factsheets/VitaminD-Consumer/ [2] https://www.hsph.harvard.edu/nutritionsource/vitamin-d/ https://www.hsph.harvard.edu/nutritionsource/vitamin-d/ (click to expand the 'immune function' section) [3] https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-... [4] (by a UK NHS lab, one which doesn't sell supplements so it's not incentivised to report misleadingly low figures)