National Health Services – UK – patients starve, not allowed to pay for extra care.

Recent news from the UK:

1. Statistics obtained by Conservatives show that the number of patients released from British National Health Service (NHS) hospitals with malnutrition has doubled in the decade since Labour came to power, increasing from 74,431 in 1997 to 139,127. While most of the patients had nutritional deficiencies on admission, the nutritional condition of at least 8,500 actually worsened during their hospital stay. Last year, health minister Ivan Lewis admitted that patients were being starved on the wards, with some elderly patients given little more than a scoop of mashed potatoes for lunch. Often, elderly patients are given non-pureed food that they cannot chew or swallow. Food trays may be placed out of reach and simply taken away when patients are too weak to get to them (Telegraph 1/1/08).

2. To meet government targets, which require emergency department patients to be treated within 4 hours, thousands of patients are kept in ambulances outside the department for hours. Last year, more than 43,000 patients waited for more than an hour before being allowed into the emergency room.

Ambulances that are being used as “mobile waiting rooms” are unavailable to take fresh calls.

The Labour government brought in the 4-hour standard in an effort to end the scandal of patients waiting in casualty for days (Daily Mail 2/20/08).

3. British patients are being denied certain operations because of lack of worthiness, based on smoking, obesity, heavy drinking, or age. Officials are urging patients to turn to “self care” instead of physician visits.

“The threat to cut benefits to the old and the unhealthy in Britain is a clear confirmation that health care can never be free…. The threat also shows that health care can’t be truly universal, at least not for the long term, because it becomes too costly to maintain as such” (“Health Freezes Over,” Investor’s Business Daily 1/29/08).

4. One way to relieve strains on the system is to allow patients to pay privately for portions of their care””while still receiving “basic” care from the NHS. For example, patient Debbie Hirst, who has metastatic breast cancer, was attempting to raise $120,000 to pay for Avastin, a drug widely used in the U.S. and Europe but not available to NHS patients, at least not until the cancer is so widespread that treatment may be hopeless.

Such arrangements have tacitly been allowed before, but in this case the doctor delivered the news that he was getting his wrists slapped by the higher-ups. If the patient paid for Avastin, she’d have to pay for all of her treatment””far more than she could afford.

Patients “hopscotch” all the time, say paying for a timely private consultation or MRI, then getting their surgery from the NHS.

But “[t]hat way lies the end of the founding principles of the NHS,” said health secretary Alan Johnson to Parliament.

The rules for private copayments are contradictory and confusing. The idea of the NHS may be to assure that rich and poor get equal treatment, but the system is riddled with inequities. Drug availability, waiting lists, and per capita spending for cancer care vary wildly from region to region.

As Mrs. Hirst explained: I’m a person who left school at 15 and I’ve worked all my life and I’ve paid into the system, and I’m not going to live long enough to get my old-age pension from this government” (Sarah Lyall, New York Times 2/21/08).

Could that be the main point?

from  the American Association of Physicians and Surgeons  –

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