We Brits like to whinge about the NHS. It’s apparently inefficient with long waiting times and poor service. Yet despite its faults, I’m a fan. Why? Good or bad?
I’ve always been generally supportive of the concept of the NHS, but this support has grown over the last few years, partly driven by greater exposure to private healthcare systems through the internet. What really made me sit up and think was the realisation that in the current climate, I might be worried about my job security, but the issue of losing private healthcare coverage if I were to lose my job doesn’t feature on my agenda. Equally, I’ve never contemplated how I’m going to be able to afford my next bottle of insulin and I’ve never made healthcare choices based on what’s on special offer in the pharmacy or online pharmacy .
In the UK we have the National Health Service. Free at the point of use, which is why I’ve never had the worries above. However, it is not, contrary to popular myth, free. In 2007 the NHS annual budget was £104 billion, which works out at a cost in tax of around £1,800 per person in the UK.
Many things infuriate me about the NHS. The fact that it takes over a week to type a letter and that healthcare for chronic conditions like diabetes is generally delivered 9-5, Mon-Fri (we still don’t seem to have worked out that patients have jobs too).
Another issue with a state run system is that it’s hard to find a clear motivator for overall improvement. Private providers drive for efficiency so that they can increase profits. The NHS doesn’t have profit, indeed if it doesn’t spend its allocated budget in a particular year it tends to be clawed back, meaning a huge drive to spend as the end of the financial year approaches. Good use of tax payers’ money? I think not.
So it has it’s faults (believe me, I could go on!), but as someone with a chronic condition I believe the concept of the NHS is a solid starting point from which we can improve.
I have the luxury of knowing that while I live in the UK, being able to afford basic life support like insulin will never be an issue for me. Most of the issues I have with the NHS I can fight to change. My own personal behaviour influences how people react to me, so I can manage their expectations . When I don’t feel I’m getting good care eg I want a pump and CGMS and can’t get one, I appeal. I work the system. I gather my facts and drive the organisation to consider my case, bringing in whoever I need to support my case, be that the Chief Exec, my MP or the press.
I admire the way a lot of American patients manage their healthcare providers like they’d manage any other supplier. In the UK, we don’t generally do this. There’s a perception that patients should be grateful for what care they get because it’s free (it’s not, its £1,800 a year, you’re paying for it!). Therefore many people don’t feel it’s appropriate to question or challenge the system. As customers, we’re not particularly demanding of the NHS.
I believe a change in the way patients act would help to improve the NHS. I treat my healthcare team like any other supplier I interact with – my bank, solicitor, electric company, car dealership etc. I try to build a good relationship whilst making my expectations clear. I provide constructive feedback – positive and negative so that they can improve. I’m conscious of my obligations – I turn up punctually to appointments armed with the relevant data. I act like an equal partner in the relationship but I have to admit, it takes a strong person to do it and it can be quite a battle to overcome a sometimes overpoweringly paternalistic approach!
But when it comes down to it, as someone with a chronic disease, I chose the cosy state owned option complete with all its faults. Why? Because I was gobsmacked when I read about people in one of the world’s richest countries, the good old US of A not knowing where their next bottle of insulin was coming from and having to balance the cost of diabetes medication against other essentials like food.
That, for me, is too great a price to pay. The NHS has many flaws but does react to pressure if push comes to shove and while we work to improve it, people are still receiving good basic healthcare. The NHS gets my vote.