LSE analysis of NHS says patient outcomes are very poor, "holy cow" status stops improvement

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ToneControlToneControl Frets: 11789
https://mises.org/blog/does-britain-have-world’s-best-health-system-only-if-you-ignore-outcomes

This is from a very different perspective to what I normally hear/read

Anyone have any insight on this?
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Comments

  • richardhomerrichardhomer Frets: 24793
    I have experience of its inefficiency.

    I went to the doctors with a lump on my left earlobe. I was advised it didn't look 'concerning' - but best to have it removed, so I would be referred for surgery. 

    After some weeks, I called the surgery to say I'd heard nothing and was advised I should receive a letter 'soon'. After another few weeks, I called the GP again and was told they would look into it and call me back. When they rang back, I was advised that the referral had been lost - so they would resend it. Meanwhile, the lump was getting bigger....

    I received an appointment to attend a minor surgery unit at another GPs. The surgeon had a look at it and advised that as it was very close to the jugular vein, that she wanted an ultrasound, before tackling it. So a referral was made for this - and I attended a few weeks later at a local hospital.

    I received a call from the GP advising I needed to go in to discuss the results - which I did - only to be advised that they would be referring me back to the minor surgeries unit.

    The MSU wrote back to my GP, advising they didn't fancy doing it - so I was referred for a consultation at the local hospital's ENT department - after which I was booked into a local private hospital for sugery....

    I've no idea how much that chain of events cost the NHS - but it certainly wasn't cost or time efficient.
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  • guitarfishbayguitarfishbay Frets: 7953
    edited July 2017
    Not much - since it was mostly administrative screw ups, referring to a cheaper service first is common practice and in theory saves money if they can handle it (see also GPwSI - special interest GPs that have a higher level of knowledge in a specific area, i.e. Dermatology etc, cheaper than secondary care).

    But it definitely was massively unprofessional and reads like you got fobbed off the first time you called up. The second time around I'm not sure why you were referred back to the same place, but all the referrals get triaged so rejections happen ahead of time (so that slots aren't wasted on inappropriate patients for that service). Still definitely not great to have further waiting.

    Private hospitals can be referred into already for many straightforward ops with minimal complications. They generally can see routine stuff faster too. They do have a larger list of exclusion criteria so the stats for them are never like for like - this is a typical list [choose and book is NHS Referrals] http://www.circlehealth.co.uk/gp-information/bath/exclusion-criteria

    Personally I've been misdiagnosed multiple times by Hospital Drs... I had a run of bad health in my early 20s - one time being told I had a much more serious condition than I did, and another being sent home twice by A&E only to wind up so ill I couldn't swallow water without throwing it back up and needed surgery within a day.

    The NHS is absolutely not perfect, but looking at the brutal cost in the States I'd rather keep it and try to find better ways to improve it. I know someone here will come and quote private prices for a healthy person and I'm sure it'll be reasonable based on that one set of maths. 

    If you have money in the UK One cost effective option is to see a specialist Privately for a consultation and to be referred into the NHS for the procedure. That often skips out weeks if not months of waiting for the first consultation, and is much cheaper than doing the whole thing privately.
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  • FunkfingersFunkfingers Frets: 14321
    The NHS is forever hamstrung by the idealist notion that it should, simultaneously, provide the finest service imaginable AND be free at the point of delivery. In 1948, this was just about possible. There was only so much that medical science could do for an individual patient. Societal expectations were more realistic. There were considerably fewer individuals drawing on the resources.

    The sacred cow aspect is significant. We are not supposed to mention that our "emperor" NHS has no clothes. The fear must be that it might collapse under its own weight or disappear in a puff of smoke salbutamol. 

    The pie-in-the-sky idealism should have shrivelled away decades ago but, because this is Britain, everything has to be fair and, moreover, be seen to be fair. Result - equal shares of misery for all. Fair but unhelpful.

    A realistic solution might be to keep Accident & Emergency free at the point of delivery but make everything else chargeable. There would be a corresponding reduction in direct taxation and an increase in health insurance. This would, of course, be considered unfair but at least it has some chance of funding itself.
    Be seeing you.
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  • guitarfishbayguitarfishbay Frets: 7953
    edited July 2017
    I think it'd be fair to charge non attendance fees if there's no credible excuse. There is a knock on effect on waiting times for all patients as well as a waste of money from the NHS budget. It's a big problem in a lot of GP Surgeries and in the big picture there isn't a lot that can be done. 

    http://www.gponline.com/exclusive-patients-fail-show-14m-gp-appointments-year/article/1351972
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  • olafgartenolafgarten Frets: 1648
    I wouldn't trust LSE, they got a Bronze rating on the TEF. :) 
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  • John_PJohn_P Frets: 2744
    Almost exactly two years ago I damaged my knee and could hardly walk. After a year of having appointments made by the hospital cancelled and continually moved on I gave up waiting and went private. With the aid of my GP and paid for the consultation and then the NHS paid for the operation and follow up physio.
    All good.  
    However the nhs hospital have continued to sent appointment letters followed by a cancellation and a new date for me to see their surgeon - I had one a couple of weeks ago, 10 months after the op.    For the first few I kept ringing to say it was fixed but they still keep coming - at least 6 since the op.  I assume I'll be in their system forever.  

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  • GrunfeldGrunfeld Frets: 4027
    edited July 2017
    I think it'd be fair to charge non attendance fees if there's no credible excuse...
    Amen. 
    I work part-time NHS; part-time private.
    People can be odd -- they just don't seem to get the cost of a DNA (Did Not Attend).
    A week ago I found myself waiting for a new client who DNA'd.  I wrote a super-polite email saying, "sorry you couldn't make it this morning."  No mention of charges or anything.  (Basically, I'd written it off and didn't expect any further contact from the time waster.)
    But the client wanted to re-book, with the excuse of, "I'm sorry, I forgot.  I won't do it next time!"  I said no problem, we'll just add the cost of wasted room rental and a nominal charge for my time to my fee -- outrage!  "I'm not paying for treatment I've not had!"
    I didn't bother to waste any email electrons with a reply.

    But my work in the NHS has a higher DNA rate than my private work.  It's not really a like with like comparison, but feck me, DNAs cost a lot of time and money. 


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  • mellowsunmellowsun Frets: 2422
    This may be the future

    https://www.gpathand.nhs.uk/


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  • chillidoggychillidoggy Frets: 17136
    edited July 2017

    I have a positive view of the NHS in general. I've always been well-treated, and reasonably quickly, too. The only real gripe I have is getting a GP's appointment in the first place. Once that major hurdle has been overcome, the rest falls into place.

    DNA's are a scourge. I think it's precisely because the service is free that they seem to ignore the huge costs of them not showing up. I always receive text reminder for my renal consultant appointments, although I wouldn't dream of missing one anyway. That's a good system.

    DNA's should have the option of either charged a fixed fee, or being made to run in front of the bulls at Pamplona wearing a red T-shirt.


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  • ToneControlToneControl Frets: 11789
    I wouldn't trust LSE, they got a Bronze rating on the TEF. :) 
    heh, yeah, despite being in the top 30 worldwide
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  • FunkfingersFunkfingers Frets: 14321
    Grunfeld said:
    People can be odd -- they just don't seem to get the cost of a DNA (Did Not Attend).
    Present the information differently and these people might just twig. Explain how much their National Insurance contributions are increased due to non-attendance by others.

    Bottom line - a service that is notionally free is taken for granted.
    Be seeing you.
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  • FretwiredFretwired Frets: 24601
    edited July 2017
    mellowsun said:
    This may be the future

    https://www.gpathand.nhs.uk/


    My GP surgery already does that - you can have a same day telephone call with a GP or an appointment which may be a week away.

    The NHS is unfixable. It will collapse at some point.





    Remember, it's easier to criticise than create!
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  • WezVWezV Frets: 16541
    Grunfeld said:
    I think it'd be fair to charge non attendance fees if there's no credible excuse...
    Amen. 
    I work part-time NHS; part-time private.
    People can be odd -- they just don't seem to get the cost of a DNA (Did Not Attend).
    A week ago I found myself waiting for a new client who DNA'd.  I wrote a super-polite email saying, "sorry you couldn't make it this morning."  No mention of charges or anything.  (Basically, I'd written it off and didn't expect any further contact from the time waster.)
    But the client wanted to re-book, with the excuse of, "I'm sorry, I forgot.  I won't do it next time!"  I said no problem, we'll just add the cost of wasted room rental and a nominal charge for my time to my fee -- outrage!  "I'm not paying for treatment I've not had!"
    I didn't bother to waste any email electrons with a reply.

    But my work in the NHS has a higher DNA rate than my private work.  It's not really a like with like comparison, but feck me, DNAs cost a lot of time and money. 


    Im fine with the idea of a DNA charge as long as it works both ways.  I spent 3 hours sitting in a waiting room last year for a consultation.  The first thing he said was "do you know why your here?", apparently they had spent 3 hours trying to figure it out and decided just to ask.

    i had some issues a few months before so just assumed it was a follow up.  Apparently not.
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  • FosterFoster Frets: 1100
    Regarding the amount of DNA, I was one about a year ago for an eye examination.

    The reason was I received the letter telling me that my appointment date was the day before they had sent the letter...
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  • FretwiredFretwired Frets: 24601
    WezV said:
    Im fine with the idea of a DNA charge as long as it works both ways.  I spent 3 hours sitting in a waiting room last year for a consultation.  The first thing he said was "do you know why your here?", apparently they had spent 3 hours trying to figure it out and decided just to ask.

    i had some issues a few months before so just assumed it was a follow up.  Apparently not.
    DNA charges would cost more than was collected. A waste of time and effort.

    The problem is simple. Not enough GPs. And the reason for that is not enough people are allowed to train to become doctors. The government deliberately restricts numbers to keep costs down.

    Remember, it's easier to criticise than create!
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  • scrumhalfscrumhalf Frets: 11262
    I have had considerable recent experience of the clusterfuck that is NHS hospital admin. Everyone knows about it, nobody seems prepared to do anything about it. It's been going on for years.

    Why nobody wants to do anything about it to enable NHS money to be able to be allocated to health services and not legions of people who either cannot or will not administrate efficiently is a mystery.
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  • mellowsunmellowsun Frets: 2422
    scrumhalf said:
    I have had considerable recent experience of the clusterfuck that is NHS hospital admin. Everyone knows about it, nobody seems prepared to do anything about it. It's been going on for years.

    Why nobody wants to do anything about it to enable NHS money to be able to be allocated to health services and not legions of people who either cannot or will not administrate efficiently is a mystery.
    This relates to the 'idiots at work' thread. Most people rate themselves as hardworking but in fact productivity is very low.

    This is why I like working for startups - dead wood isn't tolerated and if you don't perform, you are out the door.
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  • TimmyOTimmyO Frets: 7349
    https://mises.org/blog/does-britain-have-world’s-best-health-system-only-if-you-ignore-outcomes

    This is from a very different perspective to what I normally hear/read

    Anyone have any insight on this?
    If you haven't already it's worth reading up on the Von Mises Institute - it will give some perspective for the article and the perjorative language throughout. 
    Red ones are better. 
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  • EvilmagsEvilmags Frets: 5158
    The Mises institute is one of two US based think tanks that promote Austrian school economics. (Cato being the other). The student concerned will be a postgraduate economist so certainly more qualified than the majority of journalists to analyse and comment. 
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  • ToneControlToneControl Frets: 11789
    All the coverage I ever see is normally variations on:

    1. The NHS is in crisis
    2. All nurses are "angels"
    3. Nurses are underpaid
    4. All NHS staff are overworked 
    5. the NHS is the best in the world
    6. The tories are planning to deliberately destroy the NHS (baffles me, since only 11% of Brits have private health care, so clearly the cast majority of tories need the NHS for non-emergency and A&E)
    7. the NHS is being privatised
    8. The NHS is being packaged up ready for privatisation
    9. the NHS can only survive with immigrant staff
    10. NHS is inefficient
    11. Doctors are underpaid and overworked
    12. Only labour can protect the NHS
    This article goes beyond that, and alludes to the path conversations usually take:
    The utterly unparalleled degree of moral outrage which greets any criticism of the NHS bespeaks the decades of propaganda — in the state’s schools, from the state’s politicians, and on the state’s news and media outlets — which have taught the British people to believe that the only alternative to a state-controlled healthcare monopoly is for the poor to die in the streets. So pervasive has this myth become that the Labour party has been able to base its entire electoral strategy, for decades, on painting themselves as the only party that truly cares about ‘our NHS’, and a recent survey found that, when asked ‘What makes you proud to be British’, the NHS was the nation’s most common answer by a considerable margin. All this has led to a situation wherein the desperately needed reforms to Britain’s healthcare system cannot even be discussed, due to the irrational overflowing of blind rage and uncomprehending contempt that greets any criticism of Britain’s ultimate sacred cow.

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