It’s been a strange week in comparison to normal. My enforced housebound status due to having my toenail removed on Monday has meant I haven’t got out. This has meant I’ve completed lots of jobs (mainly techie) that I’ve been meaning to do for a while and I’ve completely exhausted every one of my RSS feeds in terms of my media consumption.
Every blog I read has been read, every media feed I have has been read, I’ve polished off Zelda the Twilight Princess and gone back through it to find all the hidden stuff, built my Lego Star Destroyer and have found myself at a loose end.
This led me to hunt out some new stuff to consume. I rarely get round to reading the online sections of newspapers, save for the dear old Express and Swastiki for pure frustration at how bad journalism can get but I found myself at the Guardian’s comment is free section. More precisely at this article by Polly Toynbee.
Haven’t read anything by her for years, which may sound odd being a leftie politico type but it’s true. However it made me remember that I’d been planning to write a piece about the impact of consumer society values on expectations of public services. I wasn’t planning on concentrating on the health service in particular but it is a very good example.
I’m not going to reiterate what Polly Toynbee has written, just read her article to get the jist but what struck me most was the comments to her article. I managed to get about half way through before I gave up in despair at the number of people slagging off the NHS, moaning about how much taxes they pay for it or doing down what we have in the UK and comparing it to other countries that have ‘better’ health services.
So I thought I’d share a bit of my own personal experience of the NHS.
I don’t use the health service much, I’ve only ever had one procedure done and short of a few trips to the GP for a bit of professional opinion and the odd bottle of jollop that’s about it. The only procedure I’ve had is the one that took place on Monday to remove my ingrowing big toenail. I visited my GP about five weeks ago because it was painful, he diagnosed it, referred me for the operation that should have been in about four to six weeks so five weeks is pretty much on the money and I had it done. I went back today as the operations are carried out at my local clinic in the town, a walk of about 200 yards to have my dressing changed and that was it. I don’t know how much this procedure cost the NHS nor the cumulative cost of my few visits to the GP over the years but I’d hazard a guess hardly anything compared to the proportion of the taxes that I’ve paid into the system to pay for its running.
The strange thing about this, at least if you are to believe some of the comments on Toynbee’s article is that I’m quite happy about this situation. I am quite happy to pay taxes to run a service that I do not wish to use. I’m happy because I’m not able to predict and control everything in my life. I do not know that one day one the arseholes who speed past my house isn’t going to knock me over and I end up in A&E with the requirement for a lot of treatment. I don’t know if I may suffer from an illness like cancer or suddenly have a heart attack but I do know that I quite like the idea that if I do, then I don’t have to worry too much about it because I won’t have to suddenly fork over thousands of pounds to cover the cost or find out suddenly there’s a clause in my health insurance that “doesn’t cover that condition or illness”. Such as I don’t mind that from my own perspective up till now I’ve paid thousands into the system for other people’s care and treatment, because come the day I may need treatment for something serious, those very same people may be the ones paying in to cover for my treatment. Personally however, I’d be quite happy to pay into the system for the whole of my working life and never have to have had another procedure done other than the one I’ve just had.
There were also numerous comments about waiting times for procedures and of course of a negative nature so I thought I’d add a few examples. I waiting five weeks to have a minor bit of surgery done relating to a condition that caused me minor discomfort but nothing agonising. I’m reminded back to about 16 years ago when a relative of mine had the same condition. He waited over six months for his operation and apparently that was a reasonable time to expect to wait in those days to have an ingrowing toenail removed. I think I quite like the way things are now because despite my condition being a minor discomfort for the period of five weeks, I don’t think I would have fancied it for six months, not even taking into account how the condition can get progressively more painful the longer it is left.
Second example. My mother had a problem with her ear a few months back. She went to the GP who referred her to a specialist at New Cross hospital in Wolverhampton which took about a fortnight. He saw her and asked her if she’d like to come back the following day to have the procedure done. Not sure about how other people might see that, but having the procedure done the next day seems rather a good service by my standards.
I’ll touch on a bit of comparative health provision which always comes up in these arguments usually about why our health service isn’t ‘as good’ as for example the French, German or Nordic ones. I won’t go into the old debate of comparing it to the US system of individual health insurance as it’s been done to death apart from noting that purely from an administrative cost analysis our system wins hands down in terms of efficiency. It’s simple, one form to fill in, if you’re registered as living at an address in the UK you can get an NHS number and that’s about it. You don’t have to pay for treatment at the point of need and whether you’re taken sick in Wolverhampton, Edinburgh or Machynlleth you can get treatment at the nearest hospital without any hassle. I use that example deliberately as you will see in a minute.
Now I will admit to not knowing much about the French health service apart from it’s based on a combined system of people paying for it through taxation and private health insurance. Germany is pretty much the same which I do know a bit more about for obvious reasons. Is it better? Well yes if your measurement of comparison is in terms of the potential wait you may have for things to get done. Perhaps this is part of the national psyche of the Germans? They don’t tend to like to wait for things, something very evident in Mrs Penguin and with their combined state funded and private health insurance system they get a faster service than we do. Of course they pay for it, not only through higher taxes but also having to afford private health policies on top and we are back to the old adage of getting what you pay for. Whatever rubbish is spouted by the right of British politics we have it fairly good in the UK in terms of taxation, both personal and business. What we have is a health service that is effectively done on the cheap because of the conditions under which it is expected to run. Despite its detractors it’s a pretty damn efficient organisation, of course more could be done but given how we pay comparably less for our health service than our near neighbours on the continent we get a pretty good deal.
Moving on to the Nordic model of which I know more about, in particular of the Finnish system having lived there. Theirs is in essence more comparable to ours in that it’s a directly funded for by the tax-payer system unless things have radically changed since I last lived there.
However here’s why I used the example of our own where it doesn’t matter if you’re in Wolverhampton, Edinburgh or Machynlleth when you need treatment. Much as the Finnish health system could be considered better than our own, less waiting times, better facilities etc etc, it’s not a ‘national’ health service. It’s funding comes through local taxation which on one hand is good in terms of being able to tailor treatments to more specific local areas but if for example you live and pay taxes in Tampere and just happen to be visiting Helsinki when your appendix starts to burst and there have been some examples of this. The doctors in Helsinki have been known to ship the patient 120 miles north back to Tampere so that they pick up the cost.
Personally if I happen to be in Sheffield and my appendix starts to burst I’d quite like to be taken to the local hospital and it done as quickly as possible there than be shipped back to Wolverhampton and that of course raises the issue of what is the overriding priority? As much as the Nordic system is very good, it doesn’t preclude the possibility of costs and funding overruling clinical patient care. I’ll just add that there’s actually another type of health service structure in Finland that I haven’t mentioned, that for students which is completely different and funded through membership of the local student union which is compulsory and has to be paid for. I won’t go into too much detail but over there students unions are very much a part of the social welfare structure as opposed to the organisers of piss-ups at universities over here. (that is a deliberately flippant remark for humorous value, yes I know they do some very important student welfare stuff here too before someone complains but in comparison it is nothing to the extent that they do in Finland)
What’s the conclusion? Well much as we would all want our treatment done the next day, it’s quite clear that in Britain people are not willing to fork over the extra money in taxation to pay for it. We have a pretty good and efficient health service that operates on significantly less money than those in France, Germany and the Nordic countries so we can’t really complain that much. We are spending more on the NHS now than we were under the Tories and the improvements in service and significantly lower waiting times are there to see but for some reason people seem not to understand this expecting everything to be done yesterday and of course not willing to cough up the extra cash to achieve this aim. Something for nothing I think that is called and it’s a very childish perspective to take which perhaps is a sad reflection on the society in which we live.
[note] I’d originally titled this article “In pursuit of happiness” and intended to go on to other areas but I’ve decided to keep it more focused on health issues. I’ll do the more general theme another time.