Nurses for Reform Blog

Ladies and Gentlemen, in 1948 the British government put a leaflet through the door of every household. It said, in black and white, that: “the NHS will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it.”

Today, we live in a country where our political class is seemingly proud of the target that: “the longest you should wait after being referred by your GP until you start your treatment is 18 weeks”. More than 4 months. There is even a web site called:

www.18 weeks.nhs.uk !

Today, there are tens of thousands of people trying to get onto these waiting lists. Many are delayed so that the official 18 week clock does not start to tick.

According to Professor Julian LeGrand of the LSE, people from professional and managerial backgrounds access – on average – more than 40% more NHS resources per illness episode than those in lower social groupings. Today, 1 in 10 people in NHS hospitals pick up infections and illnesses that they did not have prior to being admitted. Over the last five years, more than 30,000 people have died from Healthcare Acquired Infections related to NHS care.

Indeed, things are now so bad in our state health service, that even basic nutrition has become an issue. According to the National Patients Safety Agency, NHS malnutrition incidents rose from 15,473 in 2005 to 29,138 in 2007. Overall, during this period, almost 70,000 NHS malnutrition and starvation “patient incidents” were reported.

Today, as students at this fine university, you are residing in a country that is a long way from the politicians’ promises of 1948. You are now in a country were where some 7 million people have private medical insurance. Where 6 million people have private health cash plans – many of them are members of trade unions. This year, 8 million will pay towards private complementary treatments. And many, many, tens of thousands of others will chose to self-fund for private surgery and treatment.

More than a quarter of all people in nursing and residential care homes now pay privately. Spectacles went private back in the 1980s. Dentistry is now going – as many of you will know – the same way.

Today, in 2010, the NHS is not doing all medical, dental and nursing care. Far from it.

Sometimes, the NHS does get things right. But, all too often, it does things badly. As my good friend Dr. Eamonn Butler put it a few years back:

““If a privatized health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatization. For that matter, if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profits, or to putting shareholders ahead of patients.

Now, given the side of the debate I am on this evening, I wish I could tell you that America has got it right. It has not. I wish I could tell you that America is a genuine free market system. But it is not. Instead, away from all the propaganda and all the statements of those greedy vote-motivated politicians, America has much more of a mixed economy than most on this side of the pond realise.

Today, the US taxpayer spends a fortune on its Federal healthcare programs: Medicare, Medicaid and S-Chip. Who do you think has the larger budget? The Pentagon; or US government healthcare programs? The Answer, is US government healthcare.

I ask you: historically, which government do you think has spent a greater proportion of its GDP on its government healthcare programs: Britain or America? Well, averaging the last thirty years, the answer is America.

We hear a lot in Britain about the poor in America. We hear a lot about the 45 million uninsured. But who are they? 17m of the 45m live in households with incomes above $50,000. That is 38% of the uninsured in America. 9 million – or 20% of the uninsured – live in households bringing in more than $75,000 a year. And then there are the young-invincibles. These are the 18m Americans aged between 18 and 34 who chose to spend 4 times as much on alcohol, tobacco, entertainment and dining out, than they do on out of pocket spending on healthcare. They represent 40% of the uninsured in America.

Today, US federal law dictates that American hospitals have to treat – irrespective of ability or willingness to pay – anyone who comes within 250 yards of their Accident and Emergency department. That, my friends, is why so many Americans don’t bother with insurance. Many know that the government will already be there for them.

Now, there are probably 9 million people in America who are genuinely outside the system. But they refuse assistance and help from all sectors: be it public, private or charitable. We have those people here too: the homeless, the dispossessed, the mentally ill. For whatever reason, they want to operate on the edge of the mainstream and tonight they will probably be looked after by the Salvation Army or a myriad other good people in the independent charitable sector.

I could have talked tonight about how an American cannot buy insurance from another state. Or how the government skews the whole US insurance system so it rests with employers. I could have talked about the need for tort law reform. But, I don’t have the time to touch on these matters.

Instead, I simply want you to understand the size of US government intervention in healthcare, and to understand that like our own system, it has precious little to do with a free market.

However, I still believe that the US system is generally, better than ours in the UK. Overall it provides better rounded, more timely care for patients of all backgrounds.  This not only means that in America patients have better access to the most up to date medicines, medical and surgical procedures. It also means that if they need a hip replacement or cardiac surgery they are not left for months, or years waiting in pain or unable to leave their homes, as happens in the UK.

Indeed, I believe both systems would be better if they were more open, diverse and competitive. In short, if they were more free market.

I am not a politician. I am not an eminent medical doctor. I am a nurse. I have worked in and around the NHS for more than 25 years. And my concern his high quality patient care.

Away from Westminster, the Royal College of Surgeons and all the other vested interests, it is people like me, day and night, at ward level, who know and can talk about, the harsh realities of the NHS.

What I know, is that in this country today, most families have a horror story about the care, they or a loved one, has received in the NHS. Today, I know people find it difficult to get GP appointments. People are not able to register with NHS dentists. Increasingly, they are not always able to get the ambulances they need… When they do get one, they sometimes wait outside accident and emergency departments because the hospitals are full. If they were let in, the hospital would fall fowl of government targets on length of wait.

More than 4 months waits to get treatment? MS patients denied Beta Interferon? Patients with Kidney Cancer unable to get drugs that could prolong their lives? Women with Breast cancer not able to get Herceptin? 1 in 10 patients picking up healthcare acquired infections? 30,000 dead in 5 years? 70,000 malnourished or starved? All this, on this little Island?

You take it from me; someone who really knows;  someone who cares, on the frontline; tonight you would rather be unwell in America than here in our nationalized, vote-motivated, health system.

Thank you.