Is the NHS really the best healthcare system in the world?

The staff have to use the same facilities every single frickin day so no need to tell me! Some organisations might give the staff discount... many hospitals do not.

No. I unfortunately am not aware of any publicly available statistics, but supposedly 60-70% of complaints are about parking.

Of course there are legitimate cases and legitimate reasons to take time over what people say. Even in my example - the doctor who told people to get out was often pretty abrupt about it. The patients may feel aggrieved, and legitimately so. But there are limited resources and each doctor has very limited time - by being abrupt she saw people quickly and made beds free for newer sicker patients to come in. The patients felt less satisfied but they were more likely to receive prompt treatment, more likely to survive.

We're talking about is the paternalistic vs patient-directed models of care. The former assumes the professional knows best and should decide everything. The latter asks what the consumer wants and provides whatever that may be. Obviously the optimum lies in between. We've seen a huge shift towards patient-centred care in the last 10-15 years. For example, most med schools now attach heavy priority to communication and empathy at the expense of academic prowess. You seem to be saying it should go further, putting greater emphasis on communication at the expense of medical know-how, whereas I personally would rather my doctor was very good at treating my disease.

An example that might make you see my perspective a little more: are you a homeopathy user? The NHS now put significant money into providing homeopathy at a number of specific centres. This is a direct result of the shift to patient centred care. Doctors would never advocate money be spent on a treatment that categorically doesn't work when it could be used on cancer drugs or nurses etc. But a significant voice in the public wanted it, so the NHS managers listened and provided it. Agree with that? Disagree?

It is superficial. In the literal sense. Its on the surface and its very visible. It is not necessarily related to what's underneath.

If you attach high importance to that that's fine. Not everyone does. The private sector does indeed attach big importance to these very visible aspects for the exact reason you identified. Things that the public perceives well, like how nice food is and how polite people are, are highly controlled in the private sector and are the things that would change if we start taking a more consumerist approach to healthcare. Things like time to antibiotics, the surgical approach used, or the optimal distribution of resources to minimise mortality... not so much.

Does that not happen in the private sector? Isn't it just that we don't hear about it? Or that people just leave their job and work elsewhere?

The rigid medical hierachy is pretty annoying though yes. Its way more pronounced in less developed countries though. Not sure about European/the US.

That sounds pretty bad. Just to play devil's advocate: what would you have them do? Suspend him based on the word of one patient and their family?

Another part of the problem is that doctors are a) in very short supply and b) very very expensive to train. Its not like a mechanic or Tesco sales assistant, where you can just pick up another one next week..

And I'm sure you will defend this based on your experience, but my experience of complaining against private companies has not exactly been smooth sailing either. Some have been good, others awful. Natwest repeatedly ignored me and were threatening me with bailifs, yet the instant i mentioned taking it to the ombudsmen suddenly the problem evaporated.

But yes, another way to move things towards patient-based care would be to make complains procedures even more robust. Perhaps for every complain there could be a hearing with the senior managers to explain yourself. Costly and time-consuming and again takes people away from patient care, but perhaps that is what we will see in the future based on current trajectories.

Both I guess.

Well I've never had a complaint against me so I'm basing this on other's experience and what i've observed in this and my previous hospitals.

There are different 'tiers' of complaint. First is to talk to the person you're bothered by. Next is the senior nurse in charge of the ward. Next is the formal complaints service. Next is to write to the CEO directly. Formal complaints are mostly dealt with by the senior nurse in charge of the ward and the head nurse of the hospital (i think that complaints form a good 80% of his job, for which his salary will be a good £75,000). There is lots of paperwork and every complaint must be responded to. A lot of replies will be generic as a lot of complaints are similar - perceived rudeness, not getting medication quick enough, not being hoisted into bed quick enough, and other than hiring more staff its difficult for the responder to say 'we will do x simple solution that costs no money and this problem will never happen again'. The only honest answer for 90% of complaints (that aren't about parking) is 'we'll look at our procedures to try to minimise the chance of it happening again'. That may look like its not being taken seriously, but look at the resources already committed: multiple band 6 and 7+ nurses spending huge chunks of the day, doctors having to write long and carefully worded e-mails, and then the main cost: having to document everything you do in the first place. As mentioned doctors and nurses spend literally hours doing this every day. That translates to a huge amount of money.

Personal consequences for doctors - you will hear about it. You will likely have to respond to the person who made the complaint via e-mail (or your senior will on your behalf). You will have to discuss it at your next meeting with your supervisor.

I think the incident will be treated with as much seriousness as it warrants. It can be escalated to the GMC. A serious issue will not depend on the staffing of your post, at least in theory.

As a junior you shouldn't be getting that many complaints as any conflict that starts to escalate you are going to defer to a senior anyway. As a senior trainee... I've seen it argued that if you haven't had at least a couple of complaints against you then you are not doing your job properly. They argue that its our job to protect the NHS's resources against people demanding unnecessary tests, to protect junior our staff from rude and abusive patients and relatives, and perhaps you've just been lucky but on balance, no complaints = you're too much of a pushover. One perspective anyway.

As above. If we want to divert resources to tackle this then so be it. A rigorous system for patients to highlight shortcomings is obviously important.

If the situation really is so bad then I will also agree that we need to do something. Its just that in my experience there is so much faff and admin already dedicated to defensive practice its hard to believe that much more will be gained by committing more.

Its from a lecture - supposedly there was a decent sized American study that retrospectively looked at the care of patients who were admitted to hospital and they reckoned that in 10% of cases there was a mistake sufficiently bad that you could be successfully sued for it. The actual rate of lawsuit was 1%. However, this 1% was true for both the group of patients who did have a significant mistake, and the group that did not.

I've tried to google but there are so many hits about healthcare mistakes and cover-ups (mostly from the US I might add). Not sure I'm afraid.

The rudeness bit was extension from my own experience of dealing with angry relatives, but maybe its wrong. Perhaps its just random, who knows.

Remember that you're seeing an anonymous writer writing specifically to entertain. And that of all of those writers this particular one has become popular largely because of how mean he is.

Writing about how you're 99% sure this patient doesn't have an infection but if they do then they might sue and you're struggling with the stress of the job anyway so you're going to give them treatment just because its easier and you lost your passion for making an efficient NHS years ago anyway... is a lot less glamorous. There are a lot of defensive doctors out there.

As above. Of course, no one is arguing that you should be deliberately rude or that we should not be addressing concerns. We're talking about how to allocate limited resources - to prevent the things that patients complain about, or to prevent the things that kill them.

Well exactly. At least some doctors will leave. The standard of the NHS will drop. There will be more doctors looking for private work. There may be more demand for private work. etc.

Yeah obviously pretty bad. But it appears he has been forced to change speciality as he was rubbish, which is a pretty significant action. You could have struck him off but as I say, that's a half a million pound decision. Retraining under supervision is the preferred option, which they seem to have gone with.

For the same reason it happens to whistleblowers outside of the NHS, I guess? http://www.fraud-magazine.com/article.aspx?id=4294968656

Just look at what happened to Edward Snowden!

No offence but you're really missing my point. ... You don't need to divert resources...

What I found annoying after having read through the emails myself was that they didn't even state whether they'd spoken to him or not. I'm not sure if this is to do with the whole admission of liability thing, but they didn't need to admit "Dr X may have been under a lot of stress at the time" as an explanation to do this. It was simply a total deflection of fault, insinuating that the whole thing was my aunt's fault if anything. A non-apology of the kind politicians make.

Don't you think at least saying something like "We have spoken to Dr X about the situation," Dr X having the balls to apologise for it (again, nobody acts like that and doesn't know it's completely not OK) and so forth would have improved the NHS-patient relationship a little?

Without knowing the nature of your complaint to Natwest, though (they asked you to repay a loan you never took out or something, I'm guessing?) it's hard to know why they would've been threatening bailiffs. And banks are a pretty extreme example TBH, reason being that sometimes they have power over you too and for good reason (because people can take out loans, overdrafts, etc - in some ways they're your customer too). But a "non apology" of the kind my aunt got is pretty much nonexistent in the private sector. Unless the parent of little Jimmy writes in complaining that the staff told him nicely to stop throwing their food on the floor.

I'm curious as to why you think a hearing is required, provided the complaint is detailed enough when made through email/letter. Do you think most complainants are lying or exaggerating? The NHS can always ask any enquiries they have back without speaking to the person in person. That would allow them to do it in their own time and probably save resources too. Call me a cynic though, but I used to work as a secretary for a law firm and one of the things I picked up was that people always try to avoid having stuff in writing to avoid liability, I'm guessing the NHS might prefer one for that reason?

I was under the impression that a complaint didn't "go on a doctor's record", so to speak if the NHS managed to get the patient not to chase it up further (without outright dropping it), and that the NHS often pushed for this outcome, so as to not have too many complaints on someone's record? Please correct me if I'm wrong. (Don't ask me how I know this - got a few friends who work for it too )

Out of curiosity how long would you say the NHS has been "understaffed" for? What's causing this?

Oh, I see. Would the patient necessarily know if a mistake was all that "significant," though? Like you said earlier, sometimes every blunder seems huge in healthcare. Most patients wouldn't have the legal know how to know if they could successfully sue.

Good point. Are there not a sizeable proportion of seniors who are almost proud of their complaints, though? Again, it could just be that people make a big deal out of this, but especially in certain specialties (like surgery) I've heard that they're commonplace.

What would actually have been the reason he made all those mistakes, though? Negligence maybe? That might have transferred over to another specialty though it doesn't say what he was retraining under. Are there even any other specialities where he might have doing "less serious" work?

Snowden is an extreme example as you know! Made my morning though lmao

That's an American site. Yeah, a fair share of UK whistleblowers have to deal with unfair treatment too, but a lot of NHS examples seem pretty extreme. I find it hard to believe that cover-ups would go on to that extent in a private organisation and be tolerated, unless we're talking Enron or something. For example, this lady, who even had her mum's grave trashed and stuff

The worst. It's a drain on the taxpayer. If you need a doctor then you pay for it.

France, Germany and the Netherlands are all highly rated.

Yeah. Personally I'd like to see a much leaner and focused NHS. Make working people take out outpatient insurance for the small stuff and have a complete review of NHS services so that we no longer waste resources providing transgender surgeries and hymen replacements.

It does indeed perform operations for cultural reasons, a giant waste of money. Yes, and statistically those people still suffer depression afterward.

I have to point out that the services the NHS provides to transgender people are absolutely necessary. Untreated it causes severe mental health issues and prevents people functioning in society, part of the reason why the transgender population has a stupendously high attempted suicide rate. There it as of yet absolutely no alternative treatment that has shown anything like the benefits of supported transition in improving the quality of life of these people. Even now it's suffering from a chronic lack of funding mainly because there has been a massive increase (thankfully) in the number of young transgender people coming out and seeking help. To give you some idea, I had to wait 18 months for an initial consultment appointment, and that's yonks before you're going to get anywhere near treatment. It's one of the areas where we could most efficiently improve people's quality of life compared to the amount it'd cost, but it's not done because transphobia, lack of understanding and the scumbag wing of the tabloid press make it politically unviable.