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Globalising the NHS


nomoss
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Seeing as I read somewhere recently that the NHS has dropped from 24th to 28th in the world for quality of health care when I heard this on the news today I fell about laughing. I put these things in to my 'joke box' along with such other little ditties as Tony Blair being made special peace envoy to the Middle East, bit like making Adolf Hitler peace envoy to Israel.

Probably more interesting is the borrowing of £300m by the treasury last month on top of the £385bn the B of E has printed so far.

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I'd be interested to know where you read this,Quillan, as the WHO stopped ranking health services in 2000.

As I've said before, my experience of the NHS so far has been completely positive and I don't think I could have had better treatment for my two cancer diagnoses anywhere. We are in the forefront of medical research and though there is room for improvement in every organisation I get heartily sick of NHS-bashing by people who no longer use the service.
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The problem is that the NHS is a post code lottery and that is where it fails terribly because it shouldn't be. Everybody should, wherever they live, get the same level of care. As to the rest of it you only have to read the newspapers which you can do online to read about the levels of treatment people get and I am not referring to just the DM either which does seem to take every opportunity to nobble the NHS. All I can say is that I am glad you got excellent treatment but take time out to think of those less fortunate than yourself. Obviously this sadly happened recently because the standards of care I received 12 years ago was absolutely terrible to the point that I could easily not be here today.
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I posted the link without comment just to inform on what is going on in UK under this government. (I had thought until a year or so back that they might be better than the last lot).

I think myself that it would be a good move for the NHS to get its own house fully in order before expanding overseas.

Visits to dying family members in various parts of England in the last few years, in hospitals with ramshackle buildings looking little different from our ex-workhouse local hospital in the fifties, did not give me an impression of a cutting edge service.

Also that this idea, if put into practice, would, if not directly using taxpayers' money as promised (who's going to know, though?), would divert resources and tend to create a two tier health system; it would be tempting for hospitals to use their best people and equipment where the most money could be generated. (And I'm sure that argument is down the line somewhere)

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But the French health service is also a postcode lottery from what I've read on here and elsewhere, Quillan, and this is probably true of health services everywhere. Since one of my cancer diagnoses was in Wales in 1998 (so not very recent) and the other in England in 2005 and the care and treatment I had in hospitals a couple of hundred miles apart was uniformly excellent, I stand by what I wrote above.

My young (30s) German GP in a 7 doctor practice covering my bit of Mid-Wales chose to come and practice in the UK after he qualified because he was so impressed by his experience of the NHS during a student placement here. No-one had to go out and recruit him from abroad as our small canton here in South Manche had to do a couple of years ago, when the local GP retired and the canton couldn't find a French doctor willing to come and practice in the medical desert which is our bit of deeply rural and rather poor France Profonde. A lovely Romanian doctor is now happily ensconced here with her family, but the fact remains that the distribution of medical personnel, especially doctors, is very unequal across France, far more unequal than in the UK. As I said - a postcode lottery.....
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Your description of the service you have in Wales is not much different to here. Our nearest, and what I call 'cottage hospital' is only 5 minutes away, the ambulance station ten. We also have two hospitals within 30 minutes drive and three within an hour with a brand new fourth due to open this year also an hour away. There is also a massive maternity hospital about 40 minutes away.

In 2005 my MIL died from gross neglect in a leading London hospital having been sent there for chemotherapy having contracted cancer, she basically died of malnutrition because they forgot about her. In 2008 we finally got their apology, admittance that they were negligent and a sum of money in compensation which was duly donated, in full, to Cancer Research.

In 1998 I had three heart attacks, the treatment and care was extremely bad and was finally sent to the London Chest Hospital which was built some 200 years ago and the wards still have bare floorboards from which you can get splinters in your feet hence a sign that says you must wear slippers at all times when leaving your bed. Fortunatly my wife had the sense to move me to a private hospital where I received excellent treatment (within 12 hours) by the same surgeon who would have operated on me at the LCH some ten days after my admittance. In contrast having had minor surgery here in France the quality of care both pre op, operation its self and post op in my own home was truly outstanding and equal to the private care I received in the UK. If I need a doctor here I can make a phone call, as I have done twice for guests, and a doctor will be here within 15 minutes (day or night) or an ambulance within ten minutes which fortunately I have only needed once again for a guest.

Perhaps health care in both countries is a bit of a post code lottery but one can only speak from personal experience and I know where I would rather be. In fact its the reason I moved to France.

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As the NHS puts great stress on local control and management of resources it is bound to be a postcode lottery. Without unlimited funding it is impossible to provide expensive treatments across the board and different local committees will prioritise different options. IMO the NHS needs to spend more of its budget on Doctors, nurses, auxiliary staff  and drugs etc and reduce the expenditure on management and administration.
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[quote user="KathyF"]My young (30s) German GP in a 7 doctor practice covering my bit of Mid-Wales chose to come and practice in the UK after he qualified because he was so impressed by his experience of the NHS during a student placement here. No-one had to go out and recruit him from abroad as our small canton here in South Manche had to do a couple of years ago, when the local GP retired and the canton couldn't find a French doctor willing to come and practice in the medical desert which is our bit of deeply rural and rather poor France Profonde. A lovely Romanian doctor is now happily ensconced here with her family, but the fact remains that the distribution of medical personnel, especially doctors, is very unequal across France, far more unequal than in the UK. As I said - a postcode lottery.....[/quote]

I'm not surprised that the NHS has no trouble recruiting GPs as they receive a really good wage in the UK, wheras in France (as I understand it) they get just the consultation fees of (usually) €23, and out of that they've got all their expenses to pay.

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That is presumably why it's so difficult to get doctors to come to a sparsely populated area such as ours - not enough patients to make a decent living? I find it really surprising that France, which is supposed to have such an excellent health service has such a hit and miss method of pay for its doctors.
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[quote user="KathyF"]That is presumably why it's so difficult to get doctors to come to a sparsely populated area such as ours - not enough patients to make a decent living? I find it really surprising that France, which is supposed to have such an excellent health service has such a hit and miss method of pay for its doctors.[/quote]

But it's not hit and miss is it if you think about it. Why put a shed load of doctors in a place that has little or no people.

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[quote user="Rabbie"]IMO the NHS needs to spend more of its budget on Doctors, nurses, auxiliary staff  and drugs etc and reduce the expenditure on management and administration.[/quote]

Why, is a UK doctors salary not enough. Drugs, why let the drug companies dictate the price, I mean £19 charge to the government for the prescription of dissolvable paracetamol! As the NHS is such a big purchaser of drugs it should be working on a cost + percentage and dictating to the drug companies what profit they should make. Last time I was in the UK I paid £13 for a Ventolin inhaler which cost €5.16 in France and Spain. Seems to me the drug companies are ripping off the NHS. Then we move on to agency nurses, another disgraceful waste of money.

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No one has ever claimed that the NHS offers a good clinical standard. It is pretty dreadful   in comparison with most of Europe, despite overpaying Doctors. (Just search doctors' average salary in France and the UK)

On the other hand it is 'free at the point of delivery' and it is this which has made its name.

I don't see how that can be exported.

If it were already a private company such as BUPA I could under stand, but you can't export a social model.

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Norman, I think it is a series of services that might be set up, which will of course be fee paying.

Of course, the corollary of this is that foreign hospitals might start undercutting the NHS in the UK which could be interesting, and NHS Trusts could then just become bodies.

 

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[quote user="Quillan"]

[quote user="KathyF"]That is presumably why it's so difficult to get doctors to come to a sparsely populated area such as ours - not enough patients to make a decent living? I find it really surprising that France, which is supposed to have such an excellent health service has such a hit and miss method of pay for its doctors.[/quote]

But it's not hit and miss is it if you think about it. Why put a shed load of doctors in a place that has little or no people.

[/quote]

But we weren't talking about a shedload of doctors in the example I gave, just one solitary GP in a small French canton, yet no French doctor was willing to come there. Even sparsely-populated areas deserve some kind of medical coverage and paying a GP a salary, rather than having each of them be a one-person business seems to me to be a much better way of ensuring access for everyone. France has a lot more doctors per 100,000 population than the UK, but they aren't evenly spread around the country from what I've been able to research. Some departments have nearly half as many doctors again per 100,000 population as others (Provence 374 versus Picardy 239, but I bet there's as much illness in Picardy as Provence if not more. (source: http://www.connexionfrance.com/statistics-reveal-truth-on-shortage-of-french-doctors-11594-news-article.html)

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[quote user="NormanH"]No one has ever claimed that the NHS offers a good clinical standard. It is pretty dreadful   in comparison with most of Europe, despite overpaying Doctors. (Just search doctors' average salary in France and the UK)
On the other hand it is 'free at the point of delivery' and it is this which has made its name.

I don't see how that can be exported.

If it were already a private company such as BUPA I could under stand, but you can't export a social model.
[/quote]

I beg your pardon, Norman, but I reckon the NHS has offered me an excellent clinical standard throughout my 66 years of life there in several parts of the UK. I think you've been reading too much Daily Mail. [;-)] I love the way people who have had little or no personal experience of the NHS for many years seem able to pontificate on its deficiencies with such conviction.

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"I love the way people who have had little or no personal experience of

the NHS for many years seem able to pontificate on its deficiencies with

such conviction"

My health problems are a direct result of poor practice in the NHS, which the French system has bravely but too late tried to address.

I also have family who still have direct experience of it.

Of course it is impossible to generalise as I am sure there are some areas where it is fit for purpose, but my own experience a few years ago and that of my family now has not been great.

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[quote user="Quillan"]

[quote user="Rabbie"]IMO the NHS needs to spend more of its budget on Doctors, nurses, auxiliary staff  and drugs etc and reduce the expenditure on management and administration.[/quote]

Why, is a UK doctors salary not enough. Drugs, why let the drug companies dictate the price, I mean £19 charge to the government for the prescription of dissolvable paracetamol! As the NHS is such a big purchaser of drugs it should be working on a cost + percentage and dictating to the drug companies what profit they should make. Last time I was in the UK I paid £13 for a Ventolin inhaler which cost €5.16 in France and Spain. Seems to me the drug companies are ripping off the NHS. Then we move on to agency nurses, another disgraceful waste of money.

[/quote]I take your point. I did not express myself clearly. At present about 50% of NHS wage bill is spent on administrators and managers. That is what IMO should be reduced. The standard of ordinary GPs in Britain is not a high as it used to be. Being a GP used to attract people who had a vocation and were excellent at their jobs. Nowadays it seems to be people who have been unable to get specialist posts in hospitals who become GPs almost as a last resort. It gets very frustrating always seeing a different doctor on each visit. Fortunately I enjoy good health but you hear regular horror stories about poor cleaning in many NHS hospitals so I say more cleaners and less people in suits with clipboards draining the NHS budget

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[quote user="KathyF"][quote user="Quillan"]

[quote user="KathyF"]That is presumably why it's so difficult to get doctors to come to a sparsely populated area such as ours - not enough patients to make a decent living? I find it really surprising that France, which is supposed to have such an excellent health service has such a hit and miss method of pay for its doctors.[/quote]

But it's not hit and miss is it if you think about it. Why put a shed load of doctors in a place that has little or no people.

[/quote]

But we weren't talking about a shedload of doctors in the example I gave, just one solitary GP in a small French canton, yet no French doctor was willing to come there. Even sparsely-populated areas deserve some kind of medical coverage and paying a GP a salary, rather than having each of them be a one-person business seems to me to be a much better way of ensuring access for everyone. France has a lot more doctors per 100,000 population than the UK, but they aren't evenly spread around the country from what I've been able to research. Some departments have nearly half as many doctors again per 100,000 population as others (Provence 374 versus Picardy 239, but I bet there's as much illness in Picardy as Provence if not more. (source: http://www.connexionfrance.com/statistics-reveal-truth-on-shortage-of-french-doctors-11594-news-article.html)

[/quote]

"Figures from international economic organisation OECD show the average density of doctors across France is around 340 per 100,000 compared to the UK which has just 220 per 100,000. So, comparatively, France has no shortage of doctors." Fom the source you gave. Personally though I wouldn't believe a lot of what that paper prints, they have been proved to be wrong on more than one occasion.

So it would seem that there are a lot more doctors in France than there are in the UK. What is the point of setting up a doctor to service a dozen people per week when there is often more than one just down the road. Many of the Cantons round here, including my own, do not have doctors so you have to travel. Fortunatly in my case it's five minutes down the road but for others it is 15 or 20 minutes drive. Our nine doctors by the way are supported by one nurse and two receptionists where in the UK I had the same amount of doctors supported by about 15 staff. Perhaps having to pay for such luxuries  would be different if it came out their own pocket rather than the UK throw tax payers money at them.

I understand that a doctors job is not easy but how comes they can earn an average of £103,000 dropping to £81,158 if working for a primary trust (Telegraph 30th May 2012). On top of this they will receive money towards running their surgery. There are loads of people out there who's job is just as demanding and technically challenging who can only dream of such a salary.

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