Healthcare

Our anniversary weekend took a turn for the unexpected. Instead of looking longingly into each others’ eyes over champagne afternoon tea, we got to sample the delights of our local hospital.

With impeccable seasonal timing, Mrs YFG’s appendix decided it wanted out. Apparently, it had less patience than Mrs YFG and had enough of my FI nonsense.

In praise of the mighty NHS

I may complain in this article. And about everything in life. But you can turn up to any hospital in the UK and be seen and treated (eventually) free of charge. It is something to be immensely grateful for.

How much?

In doing some background research for this post I looked around to find out how much an Appendicectomy costs. The NHS tariff (link) for 2018/19 ranges from about £2,000 to £5,000. Which is a pretty hefty sum of money.

This is completely blown out of the water by the cost in the US. I couldn’t find up to date figures. But the most recent I could find (2016) gives an average cost of over $20,000!

FI in the UK

For me, this highlights one of the big reasons why us Brits (and Europeans) have a big advantage over our US cousins in saving for Financial Independence.

I know, that no matter what illness I get, I’ll be treated for free by world-class medical professionals. They’ll do what it takes for me to get better. At no point do I have to worry about insurance coverage, deductibles/excess, out of pocket expenses or getting the chequebook out (if I can find it).

Not only is that a huge financial win. It’s an even bigger psychological win. One of the least predictable, but potentially most costly one-off expenses is something I will never need to worry about.

Putting all the politics aside, I just can’t understand how people can’t get behind that.

That said…

For balance, I ought to touch on some of the frustrations.

Despite being a huge fan of the NHS it is incredibly frustrating to see how poorly it operates. Partly because with some effective management you could see how awesome it could be. Partly because it feels like the excellent, hard-working staff are being utterly let down.

Overall Mrs YFG went in for emergency surgery on Friday and left on Sunday morning with the surgery performed successfully. But hidden within that successful outcome were several bumps:

  • On Friday, Mrs YFG spent 12 hours in an A&E bed waiting for a ward bed. Despite her asking the nurses whether she could give up her bed for somebody else in need, she laid there waiting. It was only at ten to midnight she was finally moved to a ward (the sceptic in me suggests this was just in time to meet some various ‘targets’).
  • Whilst in A&E she spent 4 hours on a penicillin drip. All fine, except that Mrs YFG is allergic to penicillin. Something she has repeatedly told this exact hospital several times before. Still it’s not in her medical notes for some reason. She’s still suffering the after-effects of the reaction.
  • Whilst waiting to find out if she needed surgery she wasn’t offered water, food or IV. After 6 hours she caved in and had something to drink and eat. Just in time for the doctors to come round and ask why she was being allowed to eat and drink. Apparently, they had communicated to the A&E team that Mrs YFG needed surgery. Nobody thought it was a good idea to let Mrs YFG know that.
  • On Saturday morning, the surgery went all fine and Mrs YFG was back in her pretty fancy electric adjustable bed (which she adjusted literally every 47 seconds…) However, she then had to wait 5 hours for her post-op pain relief. Apparently, her respiratory rate was very low so morphine was out of the picture. Instead, the nurses decided that no pain meds would be a better idea. Again Mrs YFG wasn’t told any of this. After much begging on my part, Mrs YFG finally received her pain meds just before 11pm.
  • The irony is that the doctors were happy to discharge Mrs YFG provided she was given the medication to go home with. Of course, the hospital pharmacy shuts at 5pm. So by not getting their act together, Mrs YFG went without meds and taking up a bed.
  • On Sunday morning Mrs YFG waited for the paperwork to come through and get discharged. The surgeon came through at 9am to check whether she was still on the ward. He told her that she was all good to go, he’d signed off and she’d be out in an hour. Once Mrs YFG had her paperwork and meds she could go home. Four hours later Mrs YFG was still waiting for the paperwork.
  • At that point, the ‘bed master’ came round and turfed Mrs YFG out. Without her paperwork or meds. Several hours later I made a round trip to the hospital to pick up her paperwork. The meds ‘weren’t ready yet’. They’re still not ready to this day. I like to think there is a box of codeine floating around in purgatory somewhere.
  • On Thursday Mrs YFG went to visit the GP for a check-up. They didn’t know why she was there (despite having sent her to A&E in the first place). They had no records. Nor had they heard from the hospital or received any of the records. Thankfully (being a weirdo lawyer) Mrs YFG had taken along all the records which the GP transcribed down by hand.

But for the grace of god

None of this is particularly new or surprising to me (one of my close family members worked in the NHS before packing it in and going private). We know people who’ve had much worse experiences. That’s something to be grateful for.

It all rather leaves me glad the NHS is there but I hope I rarely have to use it. A bit like a parachute. It’ll do the job when you need it, though it’ll be terrifying in places and you hope it never gets to that.

Mrs YFG got through it fine. But it strikes me that she received just enough medical attention such that things didn’t go tits up.

That said, hospitals aren’t supposed to be fun places right?

All the best,

Mr YFG

P.S. A Merry Christmas to all you lovely readers. I wish you all a great time with family and friends!

21 thoughts on “Healthcare

  1. Sounds like a memorable anniversary! Glad everything worked out ok.

    My own experiences with the NHS are similar to what you have described. It is worth noting that when something does “go tits up” things click into gear and the business-as-usual omnishambles quickly (though briefly) turn into a well oiled machine.

    As you observe, systemic information capture and dissemination is the key (if unsexy) issue. Resolve that and the system would be infinitely more effective, delivering substantially better outcomes at a significantly reduced cost. Doesn’t make for as pithy or relatable election promise as “more beds, more nurses, more doctors” however.

  2. My best wishes to Mrs YFG and I hope she recovers soon.

    I find the NHS is a bit of a lottery. I nearly died as a teen because it took more than two years to receive a diagnosis for a chronic condition – put down to growing pains. My view now is that you have to make sure you survive the diagnosis period and if you do you will be treated very well indeed.

    London is an absolute nightmare. I couldn’t even find a GP to register with as they were all full and the missus took five years to get a diagnosis of – thankfully slow growing – ovarian cancer due to various moves around London. Needless to say none of her notes were transferred when she moved home and GP and hence had to start over. Once she had the diagnosis, however, she was very well treated indeed. They really were superb.

    Later in the frozen North, I discovered you could simply turn up at my local GP before 8am and be seen straightaway. The missus, now with various conditions, was nearly immersed in a system which saw her attending appointments virtually every week. She even got an MRI for an aching shoulder! Rumour had it that something like 10% of the local working population worked in the NHS – and I can well believe it.

    In my current location, the NHS seems very good for the basics. I broke my ankle and was through x-ray and A&E within about 40 mins. Woe betide you if you have something serious like cancer though as that often entails a 200+ mile round trip to a specialist centre.

  3. So glad that got sorted. It can be very nasty, I wonder did it come on all of a sudden without warning or had it been grumbling for a while. My daughter was in surgery for 4 hours as they cleared up the mess after her appendix burst. I would be happy to pay more tax for a better NHS.

    1. Well Mrs YFG was quite poorly Wednesday night. I begged her to go to the GP on Thursday – instead, she worked as she felt a bit better. Friday morning she was in a lot of pain again and this time she listened and went to the doctor!

      Thankfully, because of the quick treatment, we caught it before her appendix burst.

      I too would pay more for a better NHS. I’m not sure that there’s the political or public will for that, however. That said, value for money wise the NHS does excellently. We spend far less on healthcare than most other developed countries.

  4. great post and I have enjoyed reading your previous ones. My general experience of the NHS is somewhat similar, if you are at risk of dying through an emergency there is likely no better place to be. A friend had a heart attack after playing sport in South West London and the care was unbelievably good. A new born baby relative was in intensive care recently and again fantastic care provided by nurses and doctors. Everything else is often a shambles in our experiences as well. I took a friend to casualty again after playing sport and as it was non life threatening it was almost impossible to get much care as they were just too busy. But we are as you say incredibly lucky although I wonder how much longer this will continue without radical reform or significant additional tax contributions just to stand still given our ageing population.

  5. I see it from both sides. I recently spend 12 hours in a major trauma unit after a motorbike crash and I work for the NHS in a Non Clinical role. The problem the NHS has is that the front line staff have very little knowledge of data and how it could be used to improve the patient experience. Then again it’s not their job to know about how data moves about nor should it be. To highlight the point, I once worked in a trust that had to bring in extra clinical coders to capture the income from patients because the ward staff weren’t able to correctly identify which pathway a patient was on so the trust was losing millions of pounds in income. Thats not a criticism, just the way it is and I doubt it will change much. A nurse wants to be a nurse not a data expert.

    The other problem is the structure of the NHS. Each hospital and GP practise is like it’s own company with it’s own IT systems, HR policies, best practise working etc. If you tried to join everyone up to use the same IT infrastructure and make a secure network, it would cost tens if not hundreds of billions. To put it another way, think of the banks we have in this country. Each bank is its own entity and they are all run separably. When you talk about the banks and the bankers, thats like talking about the NHS and you wouldn’t put Natwest in with Barclays even though they do more or less the same thing (from a layman’s perspective.) Just look at the TSB systems fiasco, and that was joining up just a couple of banking systems. Imagine doing it with hundreds of NHS trusts. Going back to the cost, would you rather have an extra 100 nurses or a joined up data system. Thats the choice because there isn’t a magic money tree (as we’ve been told quite a lot.)

    Over time the systems and integrated way of working will get better. It’ll just take a long long time. I could talk to you all data about ideas for the future of the data capture using things like block chain but I think I’ve rambled on long enough.

    1. Hi Mr Five 2 fire. Thank you for sharing your insight. It absolutely chimes with my experience from the day job. You can’t run any business without good information processes in place. Let alone one as decentralised as the NHS.

      The question you pose is an incredibly difficult one. I think a lot of people would go for the nurses because in the short-term that might save lives. But in the long-run that won’t solve the issues you talk about. Trouble is better data systems aren’t tangible or sexy. Like indeedably said above, those don’t win election promises.

      That said, having seen it first hand, I don’t know how much faith I can put in the public sector to get these major IT projects done. It’s a very difficult question and I can’t pretend to have the answers.

  6. Something as elementary as insisting that hospital pharmacists work the hours required to maximise the beds available needs little in the way of IT at all, and certainly none that stretches out to other hospitals or to GPs.

    I’m afraid that people keep pointing to familiar defects in the NHS and then lack the balls to identify the key problem, which is a general stupidity of behaviour and lack of initiative among administrators, doctors, and nurses. This suggests to me that the incentive structures are all wrong, including the terms of employment. When market forces aren’t available to promote good behaviour and penalise bad, then it is necessary to devote some intelligence to devising an alternative. That can’t be Stalinist central planning, or brain-dead corporate target-mongering.

    Quite how good behaviour should be incentivised in such a huge outfit calls for radical thought, careful experimentation, and patience. “Stupid woman” May is obviously just the girl to start the ball rolling on this one, eh? Or, even less plausibly, stupid man Corbyn? Indeed, would any government obsessed with the prospects of its re-election in less than five years time ever be likely to grasp the nettle?

    It’s such a pity that the NHS was introduced by the odious Bevan – somebody brighter or more reflective might have given us a system more like the French, say.

    1. Hi dearieme. I’d argue it’s less about stupidity and more on the rigid hierarchy common across all public sector bodies. Staff aren’t empowered to make decisions. In many cases, they aren’t allowed to make decisions (for example, the May train timetable fiasco boiled down to the fact that nobody but the Secretary of State could make an executive decision). As you point out it leaves you with silly situations where the pharmacy (resource-rich, time non-critical) ends up as a bottleneck rather than beds (resource-poor, time-critical).

      I can’t pretend it’s just a public sector thing either. In the old job, I had to get approval for train fares from the managing partner (paid millions of pounds a year). Trusted to do valuations of billion-dollar companies – not to expense my train fare to Luton.

      It takes maturity and patience to relinquish control. I don’t think that’s the preserve of politicians (or many people for that matter)…

      1. I didn’t say it was simple stupidity: “a general stupidity of behaviour and lack of initiative” seems fairly close to your point. If intelligent people are adopting stupid behaviours, look at their incentives. One advantage of NHS England being so vast is that it would be perfectly possible to perform experiments in management with substantial numbers of staff and patients involved.

        Alternatively, just announce NHSexit. On 01/01/23 the NHS will be replaced by a copy of the system in Singapore.

        Mind you, this does overlook personal merit. A decade ago I was a patient at a famous local hospital. The ward was ill-run and slack. Shift change: in came a new Sister (or whatever they were called then) – a bright wee ball of fire from Scotland. Everything improved immediately. Of course her shift couldn’t last for ever. And I’ll bet her extreme suitability for the job was unlikely to lead to accelerated promotion or grand bonuses. Or even a warm pat on the back. God knows how she put up with it all.

  7. Agree with all the comments here — the data capture, retention, and sharing is in my experience the absolute Achilles’ Heel of the NHS. Over the staff are in general caring and clearly incredibly hard working in often shabby and always trying conditions. But the system is hilarious in a so-bad-it-would-be-funny kind of way if it wasn’t so important.

    E.g. My dad who’d had a major heart attack that left him mentally very impaired was struggling to discuss his situation with an alternative specialist we’d had to go in to see, prostate related I think, who was (somewhat commendably I thought) determined to talk to him at the start rather than us. He was evidently a bit surprised by my dad’s struggles… it transpired he was sitting there without the information that the heart attack had ever taken place (or if it was there somewhere he couldn’t see it at that time.)

    That is one egregious example; more trivial examples include repeated issues with drugs, repeatedly having to explain in front of my distressed father that actually he also had cancer because they couldn’t see it in his notes etc.

    It is mind-blowing that I know what somebody I haven’t seen for 20 years had for lunch today on FB but a health professional can’t see a simple front end with bits of the patient’s body highlighted in red stating current issues and linking to notes, for example.

    Also, while I’ve put the obligatory “staff are great” bit in (and I mean it) I think they can also be intransigent and bureaucratic, which I’m sure makes change very hard to implement.

    Then there are the political issues (e.g. Is getting a private company to create some system wide software tool like above privatising the NHS? Does that matter? Etc etc) which can also be counter-productive I feel.

    1. Hi TI, thank you for sharing.

      Also, while I’ve put the obligatory “staff are great” bit in (and I mean it) I think they can also be intransigent and bureaucratic, which I’m sure makes change very hard to implement.

      This is something I have reflected on. I reckon quite a bit boils down to the rules-based system that lots of public bodies use rather than a principles-based one. Ideally, the only measure you’d use for judging success would be patient outcomes. That’s quite difficult of course. Thus the focus on ‘targets’. Trouble is, those targets and processes become obsessions and focus is lost on what really matters – the patient. That’s the only logical explanation I can think of for why Mrs YFG could be lying in bed post-op without medication for 5 hrs.

      Then again, I’d be lying if there aren’t similar things going on in big corporate. It can be much the same.

      Is getting a private company to create some system wide software tool like above privatising the NHS? Does that matter?

      It’s a quandary. Personally, I found doing public sector work morally difficult. I’m not sure it’s ‘right’ (whatever that means) for this work to be dished out to consultants and the like. However, from my observations, most public bodies do not have the capabilities to deliver such projects themselves. I’d go as far to say they do not have the expertise to even spec such projects. Indeedably is far more authoritative on this matter though.

  8. Another tale. Fifteen years ago I happened to visit two different wards in the same hospital in the same week. In each a bunch of nurses was chattering around a reception desk. I decided to approach them and eavesdrop.

    One bunch was indulging in air-head gossip. The other was talking shop. From a distance I couldn’t have told you which was which. It can’t be easy to manage but it ought to be somebody’s job, and not somebody sitting on his arse in an office all day.

  9. the “bumps” you describe are disgusting and they could have put your wife’s life in danger… who cares if the NHS is “free” if when you do need it the standards are lacking? People in this country look at the NHS with rose tinted glasses, its really 5/10 on the service level.

  10. This is similar to what my partner went through a decade ago. She felt fine and an hour later she really didn’t. She was rushed to hospital to be told she had a ruptured appendicitis. A&E was fantastis but the problems started after the operation as she was shunted from ward to ward, consultants failed to appear, nurses forgot the painkillers etc. She was fine but it was shambolic. Our experience of having a baby was similar: superb during the birth, a cockup thereafter. We don’t use the NHS directly much now. We have a NHS GP but go private for anything that needs to be done.

    We do spend somewhat less on healthcare than many other developed countries, so the NHS probably offers value for money. Nonetheless, I think it’s unsustainable, especially when it gets dragged into community care, which is not what it really should be doing. We know what we don’t want (the US system) but putting the NHS on a pedestal closes our minds to other approaches. I’ve used the Australian system, which was better than the NHS in end-to-end care. To be fair, Australia spends more than us (and is a more affluent country) which probably is the only actual solution with an ageing population.

    I hesistate to mention Brexit but from repeated investment meetings with people who represent the “hard-Brexit” Tory right (and those that financially back them), one of the attractions for them of a messy hard Brexit is that they think it would make it easier to privatise the NHS and replace it with a US model. I suspect this isn’t quite the result many Leavers are hoping for!

  11. You meet the most interesting people, ZX. I have never in my life met anyone who wanted the US “model” here. Canada, France, Singapore, Iceland (!), Spain, Australia: I’ve heard those mentioned as improvements. But never, literally never, the US.

    My own experience of US healthcare was entirely positive, I admit; my employer sent me to a clinic after an industrial accident. But that was decades ago and so probably irrelevant. Everything else I know about it screams “no!”. Absurdly expensive, bureaucratic, rotten with illegal monopoly-abusing activities, tying people to jobs in what must be an economically destructive way, … No! Even their own version of an NHS – their system for “veterans” – seems to stink.

  12. Oh dear! I hope you’ve both had a peaceful Christmas. Of course, you will have been dancing attendance on Mrs YFG all this time… Hope things are settling back to normal now.

    So, yes, it looks like we all have somewhat similar NHS stories, and certainly it helps a lot to have an able-bodied and able-minded ally around. I have stories from both childbirth (won’t go into them here!), and my mum’s end of life care. If I think too much about either, it makes me sad, but I think we’re lucky on the whole, although improvements could certainly be made.

    Best wishes to Mrs YFG and happy new year 🙂

  13. I’ve experienced two NHS hospital stays in my life so far and whilst neither were perfect, I was just glad that they (and the ensuing treatment) were free. I see the NHS as a big leaky bucket – mostly useful but full of holes which aren’t being plugged.

    Hope Mrs YFG has recovered and wish you both a happy new year.

Have some thoughts or comments? Please share! (comments are subject to moderation and might not appear immediately)

This site uses Akismet to reduce spam. Learn how your comment data is processed.