More Budget Cuts increase Wait Times to see Doctor in the National Health Service

Posted by PITHOCRATES - February 23rd, 2014

Week in Review

The problem with national health care is that it is zero-sum when it comes to budgeting.  There is one big pie of funding that they divide throughout the system to pay for all of its parts.  But anyone who has ever paid attention to a budget debate in Washington has seen that there is never enough in the pie.  And no one is ever satisfied with their slice of the pie.  Worse, every department will spend every last cent in their appropriation lest they reduce next year’s appropriation by the amount of any unspent funds in this year’s appropriation.  No matter how wasteful that spending is.  Such as for conferences in Las Vegas.  Or extravagant office parties at home.

Britain’s National Health Service (NHS) is straining under the cost of an aging population.  More people are leaving the workforce than are entering it.  Which means fewer people are paying taxes.  Just as the number of people using the resources of the NHS is growing.  Forcing the NHS to do more with less.  Which has everyone complaining about their chunk of the NHS budget (see ‘Unprecedented’ cuts see GPs warn half of Britain will be unable to get appointments by Charlie Cooper posted 2/23/2014 on The Independent).

More than 34 million people will fail to secure an appointment with their doctor at some point this year, the GP’s professional body has claimed, blaming “unprecedented” cuts to funding for family practices.

The Royal College of General Practitioners said that the profession was “on its knees” and called for GPs to get a larger share of the NHS budget.

However, the Department of Health dismissed their findings – which would imply that more than half the UK population will miss out an appointment this year – as “complete nonsense” and accused the college of “sensationalising” the issue.

General practice has seen its share of the NHS budget – which totalled more than £109bn in England last year – significantly eroded in recent years, from 11 per cent in 2005/06 to 8.5 per cent in 2011/12…

“GPs and practice nurses want to provide high quality care for every single patient who seeks a consultation, and over the last decade we have increased the number of patients we see each year in England by 40m,” she said. “However [we] can’t keep doing more for less…”

“The GP survey showed the vast majority of patients are satisfied with their GP and rated their experience of making an appointment as good,” the spokesperson said, adding that GPs had been given an extra £50m to modernise services and stay open longer.

Whenever you want to see your doctor you need to make an appointment.  In the NHS that could take a few weeks.  Which is driving a lot of people to the A/E (accident and emergency departments).  Because they are sick now.  And don’t want to wait 2 weeks to see a doctor to get an antibiotic for their strep throat.

If you read the comments following the linked article you can get a feeling of what the British people think about the NHS.  And an idea of what Obamacare may lead to.  They love their NHS.  But are exasperated by it.  Some think the doctors are too greedy.  But there isn’t a mad rush to become a doctor to relieve the doctor shortage.  So whatever the pay is it isn’t enough to get people to join the profession.  Which ultimately increases the wait times to see a doctor.

The problem is that aging population.  People who remember a kinder and gentler NHS remember one before the baby boomers retired and overloaded the system.  Who are living longer into retirement.  Consuming more of the NHS’ limited resources than people did before the baby boomers retired.  Had Britain (and every other advanced economy) not reduced its birthrate around the Sixties they would not have this problem now.  But they did.  So they are.  As we will, too.  And every other advanced economy with an aging population will.  Making it a very bad time for national health care.  Yet President Obama and the Democrats have given us Obamacare at precisely this time.  Which is guaranteed to make health care in the United States worse.  If you don’t believe that just read the comments following the linked article.

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NHS Wait Times grow so long that the NHS farms out Health Care to Private Providers

Posted by PITHOCRATES - June 8th, 2013

Week in Review

Nationalizing health care will lead to longer wait times and a rationing of services due to a shortage of doctors, nurses and support staff that will be needed to treat more people.  This is what the opponents of Obamacare said.  While the proponents told the opponents that they were full of [deleted expletive].  Figuratively, of course.

But national health care does increase wait times and rations services.  And to see this all you have to do is look to Britain’s National Health Service (see NHS waiting scandal leads to private healthcare spend by Eleanor Bradford posted 6/4/2013 on BBC News Scotland).

NHS spending on private healthcare has risen dramatically since waiting time scandals came to light, BBC Scotland can reveal.

Spending across Scotland rose by nearly 60% last year to more than £40m, compared with £25m per year in the two previous years…

NHS Lothian admitted it would have to spend £10m clearing a backlog of patients after it emerged it had been manipulating its waiting time figures in order to meet Scottish government targets.

NHS Grampian consistently denied any wrongdoing but its spending on private healthcare increased as closer scrutiny was given to the way health boards were meeting government targets.

Last year its spending nearly tripled to £6.3m. NHS Grampian has the highest number of patients marked down as “unavailable” for treatment out of all 14 Scottish health boards.

Health boards are allowed to stop the waiting time “clock” if patients say they are unavailable, but the number of unavailable patients in Grampian is seven times higher than the average for mainland health boards…

“We understand that waiting times are important to patients and that most patients prefer to be treated as close to home as possible.

“The NHS Grampian Board recently agreed a £16m investment programme that will increase capacity by building new theatres and employing more doctors, nurses and support staff. The additional local capacity will be available in 2014.”

The NHS pays private sector health care providers outside of the NHS to provide the care they cannot.  A shortage of “theatres…doctors, nurses and support staff” has made it impossible for some health boards to meet the mandated NHS wait times.  Their wait times have grown so long that they fudge their reports to hide how poorly they’re doing.  One group of bureaucrats lying to another group of bureaucrats.  As one sets unrealistic goals the other cannot meet.  But the private sector can.  Because when people pay for their health care health care providers have the money to build theatres and hire doctors, nurses and support staff.

So what are the official wait time targets?  The above article links to another describing them.  Here are some excerpts (see Waiting time targets: What they mean for you by Eleanor Bradford posted 1/21/2013 on BBC News Scotland).

Legislation passed by the Scottish Parliament last year means that, from the start of this year, you have a legal right to be treated within 12 weeks, unless you’re waiting for diagnostic scans or waiting for one of the excluded treatments outlined below…

Since December 2011, no-one should have waited longer than 18 weeks from the point they were referred for treatment until that treatment occurs. This includes all scans and diagnostic tests…

You should wait no longer than six weeks for eight types of scans and tests.

These are: upper endoscopy, lower endoscopy, colonoscopy, cytoscopy, CT scans, MRI scans, barium studies and ultrasound scans (unrelated to obstetrics)…

You should wait no longer than 62 days for treatment if your referral is “urgent”.

Once a definite diagnosis of cancer is made (eg following a scan) you should wait no longer than 31 days for treatment. However, this is only the first treatment…

The waiting time “clock” stops if you are unavailable for any reason, but you should specifically agree to a period of “unavailability” being applied to your case and a letter should be sent to you confirming this to be the case.

If you can’t make the first appointment offered, you should be offered a second one.

Both should be “reasonable” – in a location you can get to and in a timescale that is possible, but it is considered reasonable to offer you an appointment in another health board area…

If you miss your appointment and don’t ring in advance then you will be referred back to your GP.

If you still need treatment your GP will need to make a new referral and the whole process starts again.

So, to summarize, you go to see a general practitioner (GP).  That’s like the doctor you make an appointment to see when you think you have the flu so you can get some antibiotics.  The GP refers you to a specialist if you have something serious.  The specialists then refer you someplace for treatment.  And when he or she does the clock starts running.  And some time in the next 18 weeks you should start your treatment.  Unless they note you as ‘urgent’.  Then your treatment is in the next 62 days.  Which is 2 months.  But if they find that you have cancer they cut that in half.

This is why their emergency rooms are overflowing in Britain.  People don’t want to wait these long wait times.  So they go to the emergency room (A/E in Britain).  Funny, really.  For this is the very thing Obamacare was going to stop in the United States.  Uninsured people going to the emergency room.  And here they are in Britain with all the free health care they could want.  Still going to the emergency room to escape those horrendous long wait times.

Perhaps the opponents of Obamacare were not full of [deleted expletive] after all.

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An Aging Population is pushing the NHS to the Breaking Point as it will push Obamacare to the Breaking Point

Posted by PITHOCRATES - May 25th, 2013

Week in Review

Britain’s Health Secretary said the problem with overworked accident and emergency rooms (A/Es) is that general practitioners (GPs) are not taking care of their patients.  Because a patient can’t make an appointment with their GP, or when they do it is 2-3 weeks later, they just go to the A/E instead.  Because they don’t want to wait.  Or can’t wait because of the pain.  Or because they have a sick child.  This is why accident and emergency rooms are overflowing.  Because the GPs aren’t doing their job.  Or so says the Health Secretary.  Something the GPs take issue with (see NHS A&E departments ‘left unsafe by political meddling’ by Nick Triggle posted 5/23/2013 on BBC News Health).

British Medical Association GP chairman Dr Laurence Buckman has given a speech pointing out the problems that lead to overstretched hospital A&E departments…

He said: “We’ve turned GP practices into places where it’s a daily challenge for receptionists to cope with huge call volumes and GPs to get through to all the people they need to see…”

Dr Buckman added: “He [Mr Hunt] does not want to bother with the facts when he can have a bash at those of us who on his own admission are overworked and strained beyond endurance.

The problem is not with the GPs.  Or with the National Health Service (NHS).  The problem is national health care.  Which may have worked well when people were having a lot of babies.  Making the population grow younger.  With more people entering the workforce than leaving it.  And those who left it had the decency to die soon.  But that was before the Sixties.  When they set up the NHS.  In the Sixties people stopped having so many babies.  Instead of the population growing younger it began to grow older.  And new advances in medical care have allowed retirees to live a long life in retirement.  So the rate of people consuming health care services is growing greater than the rate of those paying for it.  Which has overflowed A/Es.  And is straining GPs beyond endurance.

And so it will be under Obamacare.

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The Form-Based Efficiency of the NHS fails to Save a Baby from Chicken Pox

Posted by PITHOCRATES - May 5th, 2012

Week in Review

A baby dies despite the efficient use of forms in national health care (see Baby boy died from chicken pox after doctors sent him home THREE times – and all he needed was simple antibiotics by Paul Sims posted 5/3/2012 on the Daily Mail).

Hospital staff missed three vital opportunities to save a toddler with chicken pox and he would be alive today if they had acted, a coroner said yesterday.

Lewis Mullins was seen by doctors three times in three days after his mother became convinced his condition was deteriorating rapidly.

But on each occasion she was given painkillers to make her son more comfortable and sent home…

Rotherham coroner Nicola Munday said Lewis would have almost certainly have survived the infection had staff ‘heeded’ the warning signs, carried out routine tests and treated him…

She rushed her son to Rotherham’s NHS walk-in centre on Wednesday, March 30 last year and was told he had infected chickenpox.

But a questionnaire filled in by a nurse, which detailed Lewis’s pain, rash, high temperature, shaking episodes and breathing problems, was not passed to the GP who later saw him.

As a result the GP thought he was treating him for chickenpox and nothing more…

This is medicine on a grand scale.  National health care.  And what Obamacare will be like.  Where the focus will be on cost cutting and greater efficiencies.  Digitizing medical records.  Using forms and checklist discipline to process as many human inputs into the system as possible.  To make those limited health care resources stretch as far as possible.  Instead of old time medicine.  Where you have a family doctor.  And your family doctor knows you and your family.  Your family history.  A doctor that sees your children growing up.  A doctor that knows your child.  And his or her brothers and sisters.  Knowing them as children.  And not as checklists.  But we can’t have that with national health care.  And we won’t have that with Obamacare.  Because that will take too many doctors.  And too much time.  So our doctors will become strangers.  Strangers who peruse a checklist.  Then goes on and processes the next human input into the health care machine.

This would probably not have happened in the United States.  For even though health care there is still not nationalized most children receive a chicken pox immunization.

Miss Conlay is now calling for a national immunisation programme for chicken pox. Vaccination is routinely available in the United States and Canada, but it is not offered to children in the UK…

Of course one can only assume the reason why the UK doesn’t is for the same reason that directs every decision in the NHS.  Cost.  Currently immunization clearly isn’t cost-effective.

It’s not the people in the NHS.  It’s the NHS.  The system.  Which is asking them to do the impossible.  For with their aging population and rising budget deficits they have little choice but to cut costs and pursue greater efficiencies.  And even though there is this great example of a large national health care system struggling to deal with an aging population and rising deficits the United States is heading down this same road.  Only with more human inputs to the health care machine.  That is struggling to deal with an aging population and rising deficits as well.  Who likes to hold up the model of Medicare as a success story.  Even though they project Medicare to go bankrupt in a decade or two.  So enjoy your health care in America while you can.  For if Obamacare isn’t repealed these are the kind of stories we’ll be reading about.  Only on a grander scale.

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