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

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    (Original post by RiotGirll)
    Yeah, "the authors say that" this is partly down to social/economic factors but not solely.
    One simple explanation is that the NHS spends relatively little money. The NHS is 11th for "keeping people alive" and 11th in terms of spending per capita. Spend less, get less.

    But it's not obvious that that means the NHS is worse because healthcare has a very low return on spending and the return also reduces very quickly. E.g. spend 500/year instead of nothing, and life expectancy may go from 55 to 75; spend 1000/year and it may go to 78; spend 2000/year and it may go to 78.5 - not real numbers, but just examples. The authors here have judged that the NHS, while providing a worse service, does not provide that much worse a service than others and is therefore good value.

    Now if one judges health systems in terms of cost efficiency in this way then the Maldives do pretty well with a life expectancy of 77.6 coming from spending of $500/person/year ($3,600 in the UK), of which 50% is paid privately out of pocket, basically in cash. An example to emulate?
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    (Original post by the bear)
    the NHS is truly amazing. people who have ruined their health by their deliberate lifestyle choices are given top notch care for nothing. then they can claim millions of £ if the overworked staff slip up. it is like the lottery but everyone is a winner.
    I'm not quite sure which choices you're referring to but alcohol and tobacco are already taxed on consumption, so I wouldn't say they get top notch care for nothing. Hopefully sugar will be next.
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    (Original post by RiotGirll)
    Well there are alternatives to the NHS/America.

    I heard it's really good in countries like Sweden but they pay loads of tax
    France is widely regarded as the best healthcare system overall(by objective research). Farage and UKIP, perhaps ironically, have proposed a similar system for the UK.

    On the NHS, I think it's like most things with Britain currently-a great old institution not functioning anywhere near as well as it should, behind a veneer of how well we are doing, it's a bit like our economy and non-private schools, or even law and order. Results or figures are politicized and anyhow subject to sophistry-all is not quite as well as it seems. It doesn't mean that the NHS is wrong in principle, just that it is suffering from the catastrophic idiocy/cynicism/short termism of the people running this country-like most other things going on.
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    This 'envy of the world' thing is a meme British people repeat without really thinking.

    It is good, but it's better if you can go private.
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    (Original post by Hydeman)
    I can't speak for France or Germany but I'm reliably informed by a Dutch friend who has fibromyalgia that the healthcare provision there isn't all that good, especially for chronic conditions like hers.

    Does the NHS really do any of that? :/ The only instances in which I've heard the NHS provides cosmetic treatment is if somebody is unhappy with some part of their body to the point of depression.
    It does indeed perform operations for cultural reasons, a giant waste of money. Yes, and statistically those people still suffer depression afterward.
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    (Original post by RiotGirll)
    Have you used healthcare in other countries? Unfortunately I haven't
    as a lad whos been aware of 3 healthcare services. yes , yes it is. and its somehow reasonably cost effective.

    health is never gonna be perfect. but the NHS do a v good job. in terms of being more cost effective they could go for the CUBA model .
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    (Original post by SaucissonSecCy)
    France is widely regarded as the best healthcare system overall(by objective research). Farage and UKIP, perhaps ironically, have proposed a similar system for the UK.

    On the NHS, I think it's like most things with Britain currently-a great old institution not functioning anywhere near as well as it should, behind a veneer of how well we are doing, it's a bit like our economy and non-private schools, or even law and order. Results or figures are politicized and anyhow subject to sophistry-all is not quite as well as it seems. It doesn't mean that the NHS is wrong in principle, just that it is suffering from the catastrophic idiocy/cynicism/short termism of the people running this country-like most other things going on.
    I agree about the sophistry. People won't even criticise it often
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    TBH when people working in the NHS say things like this I expect they're probably talking about it being morally better... not being the most cost effective or having the best outcomes.
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    The main problem with an individual based insurance system is the people who use it the most and the most expensive are the elderly and those with expensive chronic diseases like heart disease and cancer.

    They are the ones least able to afford to pay insurance premiums because they find it difficult to work and limited income e.g. pensions. What happens is the taxpayer has to pay for these people. 60% of personal bankruptcies in the US is due to people being unable to pay their medical costs and the cost has to be picked up by taxpayers.

    The NHS is probably the least worst option compared to insurance based or part govt, part insurance based systems. These are expensive to administer because each patient has a big paper trail for even the simplist treatment.
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    (Original post by RiotGirll)
    I agree about the sophistry. People won't even criticise it often
    Yes, I guess that is in part because people on the left know how much the right is ideologically opposed to it and want to destroy it, so they are aware that even constructive criticism and pointing out bad performance could be fuel to their fire.
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    Nope. There are other European countries which arguably have better healthcare systems, whilst America has the highest quality healthcare (most advanced treatments, best hospitals, best medical schools and likely doctors too) provided you can afford it.

    The NHS is good from a certain perspective; we don't spend much on healthcare relatively speaking and manage to give everyone coverage. Actual health outcomes aren't anywhere near the top of the list though.
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    The biggest problem in the health service is morale and transparency.

    Currently, junior doctors and nurses are overworked, underpaid and are seeing safeguards being removed. The population are costing more in health care costs but budgets aren't rising to counteract this. Long term health projects have been abandoned for short term political goals. Waste is also dire, although it's too often simply used as a problem solver, when the waste is often necessary.

    We also still have a litigation situation where staff are pressured to cover up and so instead of learning from errors to reduce reoccurrence, the same errors continue to happen, so the ability of the service to evolve has been crippled.

    I fundamentally believe in very limited private intervention in the health service, but that a fully private alternative could also be put side by side. Staff need greater protection and politicians to back it. Public health need be a priority too.

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    (Original post by the bear)
    the NHS is truly amazing. people who have ruined their health by their deliberate lifestyle choices are given top notch care for nothing. then they can claim millions of £ if the overworked staff slip up. it is like the lottery but everyone is a winner.
    Nothing in life is truely free. Someone somewhere pays.That top notch care is paid for by people paying into it. It's only free to the people that don't pay in, who ironically are disproportionately the people making the deliberately bad lifestyle choices that you mention.
    The real saps are the higher earners that pay full wack for the NHS and then never use it as they pay for private healthcare on top.
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    (Original post by Aj12)
    ...becoming more and more unaffordable given the demands placed upon it.
    Its becoming unaffordable because of the population bubble of over 70s coming through. The underlying system isn't going to change that - either its unaffordable for the NHS or its unaffordable for those paying insurance premiums.

    Unless you're suggesting we just cut out the people who can't afford it. In which case I guess that would work yes.

    (Original post by Masih ad-Dajjal)
    This 'envy of the world' thing is a meme British people repeat without really thinking.

    It is good, but it's better if you can go private.
    (Original post by ChickenMadness)
    But you can pay somewhere else and get better treatment.
    I can tell you as a healthcare professional who has cross-covered in private wings, they are dangerous places. The private sector currently is there to feed off the most profitable bits only. They're set up to provide superficial comfort whilst anyone actually sick or complicated gets turfed out. Private wards are staffed with under-motivated staff grade doctors who have hit a career dead end and couldn't care less about you. They won't have basic services like experienced phlebotomists to take blood or be set up to deal with anything out of the ordinary. The second something bad happens they'll call 999 for an NHS ambulance.

    Private healthcare is good for getting your operation in 2 weeks instead of 8, and its good for making your wards look a little more plush, but medically I would steer well clear.

    (Original post by RiotGirll)
    I support the NHS but it seems extremely self serving sometimes. How many times has someone complained to it successfully for instance?
    I would argue the opposite.

    Most things people complain about are superficial and nothing to do with the patient getting better. The vast majority are a) about parking and b) about lack of communication/rudeness. Very few are 'my mum should have had x scan and their antibiotics within 1 hour of admission which would have made her less likely to die'. All complaints are mandated to be taken seriously and every complaint made ties down a senior nurse to respond to it, a senior doctor too if it involves them, taking them away from doing things like giving those antibiotics.

    You then get to litigation. You are no more likely to be sued if you make a mistake than if you don't make a mistake, believe it or not. Its again mostly governed by whether the doctor was polite or not. However when it does happen its devastating and so many doctors are terrified of the power the patient has over them. Therefore they will order scans they don't need, keep them in hospital longer than they have to and treat infections which don't exist, all of which consumes vast amounts of NHS resources. Sometimes an anxious patient says 'oh i feel ok doctor but i need to stay another day to make sure' - the best doctors make it very clear that is not an option and tell them to get out, the worst are spineless and let them stay. But its the former doctor that gets their time consumed with complaints about them, not the latter.

    And then a lot of:

    It also seems to have a lot of bureaucracy/red tape
    ... is due to doctors/nurses needing detailed record to defend themselves when they are complained about/sued. Particularly for nurses. If the public were less litigious (like they are in say Aus/NZ) you could probably save about an hour of a nurse's time per day, about 3 hours in psych nursing (where the chance of getting sued is huge). Which would greatly improve care.

    I'm not saying that doctors shouldn't have manners, nor that patients should not make complaints, but frankly i would rather have a doctor who was brief and did his job than a polite one who spent lots of time patting me on the back telling me everything will be ok. The NHS is getting way too fraught up over complaints and resources are being diverted from patient care to address these superficial concerns. I find that worrying.

    I agree. Ironically every time people do try to make cuts to prevent overspending etc. "no privatisation" is trotted out,
    That's because those things are on the same spectrum and directly related to one another.

    The options are not free healthcare vs no free healthcare. You can have an amazing NHS which totally obliterates the need for private services, or you can have an NHS which provides only the very basics and if you want anything more than a patching up you need to pay for it yourself. The latter is still technically universal healthcare, but in reality the private system is dominant.

    Every time a cut is made to the NHS we move towards the latter system. Every time more funding is provided to fill a gap we move towards the former.

    (Original post by RiotGirll)
    I think "free at the point of use" has made it a sacred cow to most British people. However a lot of blunders etc. that would lead to sackings in private companies get overlooked in the NHS because of its nature.
    Can you give me an example? Remember that basically every blunder appears 'huge' in healthcare as everything done appears really important. If you sacked someone every time it happens you'd have no one left...
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    Not really. They've told some pretty big lies (we discovered the truth accidentally) and almost killed me.

    Not had experience of other healthcare systems though.
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    (Original post by nexttime)
    I would argue the opposite.

    Most things people complain about are superficial and nothing to do with the patient getting better. The vast majority are a) about parking and b) about lack of communication/rudeness. Very few are 'my mum should have had x scan and their antibiotics within 1 hour of admission which would have made her less likely to die'. All complaints are mandated to be taken seriously and every complaint made ties down a senior nurse to respond to it, a senior doctor too if it involves them, taking them away from doing things like giving those antibiotics.
    Source on the exact stats for this? (you may be right but I'd be interested in reading them anyway). I agree, expensive parking is a big deal but not that big a deal though perhaps the public feel ripped off sometimes. I suspect the "vast majority" you refer to mostly concern (b), though, no? Nobody writes a complaint about Dr. X from the radiology department saying "oh, but the parking was £30 for 5 hours." They complain to the hospital manager. So we can separate that point.

    Lack of communication/rudeness can cause problems. Perhaps NHS staff receive training in this but it often seems to fall short, or maybe NHS culture turns a blind eye to it. If you have, for example, a doctor who pretty much throws the papers you're meant to sign at you across the desk, slams the door when he walks in, rolls his eyes when you start crying because you're suicidal, calls nurses "stupid" behind their back, etc. because he is in a bad mood (as my aunt encountered in a hospital) do you think that's not going to affect how willing a patient is to share their problems, open up, etc.? Or, if you have a doctor who doesn't listen, you think that won't affect the treatment they provide?

    I am not going to disclose too much about where this was but my aunt had mental health problems btw, serious depression which he was meant to be helping with. Nor is she rude to people like doctors. I also have friends and relatives who've had similar experiences with different medical staff/hospitals, so it's not just one person. This is not true of all or even most of the NHS (I can say having been to hospital myself) but it's certainly a problem.

    It is certainly not "superficial." Yes all industries have rude people, but unfortunately some (not all) NHS workers seem to think that they are above having to be polite to people because they work in an important area (healthcare) and are public sector workers too. At the end of the day, they may not be in the private sector but our taxes pay their wages so it's not like they're "working for free" or not working for us in a sense. When you're in a customer facing role, politeness is not superficial. I don't pay the guy at my local garage to be nice to me as well as service my car (servicing it is pretty much like healthcare in that if he makes a tiny mistake it could kill me) but if he does a great job servicing it and is also a total **** to me his boss is hearing about it and he knows it. Similarly, I can go to Tesco's and the kid on the till chucking my shopping at me before I leave isn't going to affect the food at all but I wouldn't call it "superficial" either.

    FYI, I'm pretty left wing as mentioned in this thread and support the NHS as a whole, but even if you are a "higher up" in a place like a bank or other private firm and a customer complains about you being rude, you will be called out on it. (There's a reason the tabloids make a big deal out of it when companies respond rudely to complaints about customer service - because it's so rare). I haven't been to university yet, but I've worked across a wide range of industries as I'm older than most on TSR and if I had ever been rude to a customer that way I would have expected to have gotten a good warning instead of my boss covering my behind and making excuses for me to said customer. And NHS patients are still "customers," even if it is free at the point of service.

    I'm considering applying for medicine as a mature student and doing my research on it. I am being put off by the numerous tales one hears of senior doctors and nurses being rude to other members of staff, including junior doctors/med students, even bullying them. It's not inconcievable they would do this to patients either, particularly ones like elderly patients if they think they can get away with it. I'm not saying that all/most doctors or nurses are like that, but, unfortunately, for the ones who do go on power trips there often seems to be little holding them accountable for it. NHS staff certainly often seem overworked these days (the Tories suck) but that is no excuse to take it out on patients.

    For the record, my aunt complained and she got the old "we're sorry if you're offended, Dr X and all the staff here work very hard to provide an adequate standard of care" BS back in a letter and no other mention of any action that would be taken. She emailed back asking if anything would be done about the doctor (I actually helped her write this because she's not so good with computers) and got a reply so full of misspellings/typos etc. it seemed deliberately done to put her off, saying that they had "taken her comments on board." She sent another enquiry and got no response, after which she gave up. I can dig up a fair few links showing patient dissatisfaction with the NHS complaints system if you like. It being "mandated" to take patient complaints seriously doesn't seem to have had much effect in practice. Sometimes the NHS just seems to close ranks and cover up stuff.

    Also, are you considering GP complaints or just those made about hospital staff?

    And how are complaints actually resolved? What does taking them seriously even mean in practical terms? I'd be very interested to know how common cases like my aunt's are. Does it just "go on someone's record" even if a doctor or nurse says, no, I wasn't rude to that patient who complained about me, and the NHS succeeds in its attempt to pressure the patient into dropping the complaint or not pushing it any further? What if it's a particularly "valuable" member of staff (say, working in an understaffed department?), are the NHS more likely to take their side? Will the hospital just remove the complaint if they think it's without merit?

    http://www.telegraph.co.uk/news/nhs/...an-report.html

    http://www.theguardian.com/healthcar...ent-complaints


    http://www.theguardian.com/society/2...ints-appalling



    You then get to litigation. You are no more likely to be sued if you make a mistake than if you don't make a mistake, believe it or not. Its again mostly governed by whether the doctor was polite or not.
    Again, sources? (esp. on mostly governed on whether the doctor was polite).

    However when it does happen its devastating and so many doctors are terrified of the power the patient has over them. Therefore they will order scans they don't need, keep them in hospital longer than they have to and treat infections which don't exist, all of which consumes vast amounts of NHS resources. Sometimes an anxious patient says 'oh i feel ok doctor but i need to stay another day to make sure' - the best doctors make it very clear that is not an option and tell them to get out, the worst are spineless and let them stay. But its the former doctor that gets their time consumed with complaints about them, not the latter.

    And then a lot of:
    I only wrote a few sentences which you've expanded on quite a bit, but to cut this down I agree that if a doctor actually feels a patient doesn't need X treatment/a longer stay they shouldn't give it to them.

    With respect I would disagree on the whole "terrified" thing though. . Been reading the odd blog by "anonymous" hospital doctors, etc. Again, I don't exactly disrespect them or I wouldn't even be considering applying for medicine, but a lot of them seem to downright look down on patients. (e.g. that Confessions of an A & E SHO one). Maybe it's mostly senior ones but if you have an attitude like that it probably shows.

    ... is due to doctors/nurses needing detailed record to defend themselves when they are complained about/sued. Particularly for nurses. If the public were less litigious (like they are in say Aus/NZ) you could probably save about an hour of a nurse's time per day, about 3 hours in psych nursing (where the chance of getting sued is huge). Which would greatly improve care.

    I'm not saying that doctors shouldn't have manners, nor that patients should not make complaints, but frankly i would rather have a doctor who was brief and did his job than a polite one who spent lots of time patting me on the back telling me everything will be ok. The NHS is getting way too fraught up over complaints and resources are being diverted from patient care to address these superficial concerns. I find that worrying.
    I'm not talking about doctors/nurses necessarily here, but people like NHS managers/non front-line staff too.

    You are speaking from the perspective of a doctor. There's brief and then there's being a bully because you're having a bad day due to Jeremy Hunt being a **** and thinking you can get away with being rude to the ill person you're being paid to treat.

    Also, let's be real here. Nobody except the 1-2% of really oversensitive people, or the sort who would think it OK to assault a doctor if they were angry, complains because their doctor "didn't pat them on the back telling them everything would be OK." A lot of the time somebody IS actually being disturbingly rude or dismissive, and that's not "superficial," as I explained above. Again, healthcare is an important service but it's also a customer facing one and being polite to customers is part of providing that service. It's not about being a lap-dog like a car salesman, it's about respect going both ways.

    I agree that the NHS needs more money, but perhaps the Tories should invest more money into it rather than just cutting this or that area. There are also flagrant wastes like spending £150k (IIRC) on that site where patients could write "reviews" which then got taken down very quickly again afterwards. (Because of too many bad "reviews," I suspect?)

    That's because those things are on the same spectrum and directly related to one another.

    The options are not free healthcare vs no free healthcare. You can have an amazing NHS which totally obliterates the need for private services, or you can have an NHS which provides only the very basics and if you want anything more than a patching up you need to pay for it yourself. The latter is still technically universal healthcare, but in reality the private system is dominant.

    Every time a cut is made to the NHS we move towards the latter system. Every time more funding is provided to fill a gap we move towards the former.
    For the record, I support the junior doctors striking etc., but how does cutting their salaries affect privatisation directly? (Obviously, one can see how having them leave the NHS might affect it indirectly)

    Can you give me an example? Remember that basically every blunder appears 'huge' in healthcare as everything done appears really important. If you sacked someone every time it happens you'd have no one left...
    Not necessarily. Maybe it's my perspective but obviously things like cancer screening etc. are pretty important, whereas (IMO) things like having a sprained ankle and being given the wrong advice/having dandruff misdiagnosed as psoriasis (happened to me) are not the end of the world.

    http://www.bbc.co.uk/news/uk-england...shire-30520897

    Still working at the hospital (in a different department but doesn't say which)

    http://www.dailymail.co.uk/health/ar...-hospital.html

    Also, on the topic of sackings, why does this (or being bullied) happen to so many whistleblowers?

    http://www.independent.co.uk/life-st...d-2023809.html

    http://www.telegraph.co.uk/news/heal...-patients.html

    http://www.independent.co.uk/life-st...-10046706.html

    (Original post by OU Student)
    Not really. They've told some pretty big lies (we discovered the truth accidentally) and almost killed me.

    Not had experience of other healthcare systems though.
    Sorry to hear that .

    I have quite a few friends/relatives who've used the NHS a lot.. unfortunately heard some pretty nasty stories.
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    (Original post by That Bearded Man)
    The biggest problem in the health service is morale and transparency.

    Currently, junior doctors and nurses are overworked, underpaid and are seeing safeguards being removed. The population are costing more in health care costs but budgets aren't rising to counteract this. Long term health projects have been abandoned for short term political goals. Waste is also dire, although it's too often simply used as a problem solver, when the waste is often necessary.
    I agree. Without being a **** I would say that (apart from doctors/nurses) unfortunately the NHS does not always attract the brightest minds like industries like law and finance do. People who work as NHS managers etc. often seem to have more "political" goals/backgrounds (esp. in my area) which leads to a lot of waste going on and inefficiency.

    We also still have a litigation situation where staff are pressured to cover up and so instead of learning from errors to reduce reoccurrence, the same errors continue to happen, so the ability of the service to evolve has been crippled.

    I fundamentally believe in very limited private intervention in the health service, but that a fully private alternative could also be put side by side. Staff need greater protection and politicians to back it. Public health need be a priority too.
    I suspect you're right about staff being pressured to cover up. Do you have the source out of interest?

    Yes, if you look at the links I posted above in my reply to nexttime, the NHS seems to take a very blase, "we can get away with it" attitude to a lot of complaints. I guess it's more understandable considering that they are a public health provider. If a private business took that attitude towards complainants they would be out of business pretty quickly
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    (Original post by RiotGirll)
    I agree. Without being a **** I would say that (apart from doctors/nurses) unfortunately the NHS does not always attract the brightest minds like industries like law and finance do. People who work as NHS managers etc. often seem to have more "political" goals/backgrounds (esp. in my area) which leads to a lot of waste going on and inefficiency.



    I suspect you're right about staff being pressured to cover up. Do you have the source out of interest?

    Yes, if you look at the links I posted above in my reply to nexttime, the NHS seems to take a very blase, "we can get away with it" attitude to a lot of complaints. I guess it's more understandable considering that they are a public health provider. If a private business took that attitude towards complainants they would be out of business pretty quickly
    As a med student, it's concerning to see, but it's not a "we can get away with it" attitude, it's a "we can't afford the costs or publicity" - patient deaths are seen as someone's fault so staff for fear of financial penalty or losing their job cover up mistakes. The public need to accept that errors happen, human error exists and punishing human error doesn't work. Private involvement here will worsen the situation as bosses will have more to lose and indeed staff will be under even greater pressure to not make a mistake.
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    (Original post by RiotGirll)
    I agree. Without being a **** I would say that (apart from doctors/nurses) unfortunately the NHS does not always attract the brightest minds like industries like law and finance do. People who work as NHS managers etc. often seem to have more "political" goals/backgrounds (esp. in my area) which leads to a lot of waste going on and inefficiency.



    I suspect you're right about staff being pressured to cover up. Do you have the source out of interest?

    Yes, if you look at the links I posted above in my reply to nexttime, the NHS seems to take a very blase, "we can get away with it" attitude to a lot of complaints. I guess it's more understandable considering that they are a public health provider. If a private business took that attitude towards complainants they would be out of business pretty quickly
    See attached. These are the main problems with further use of private services.

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    (Original post by RiotGirll)
    Source on the exact stats for this? (you may be right but I'd be interested in reading them anyway). I agree, expensive parking is a big deal but not that big a deal though perhaps the public feel ripped off sometimes.
    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.

    I suspect the "vast majority" you refer to mostly concern (b), though, no?
    No. I unfortunately am not aware of any publicly available statistics, but supposedly 60-70% of complaints are about parking.

    Lack of communication/rudeness can cause problems. Perhaps NHS staff receive training in this but it often seems to fall short, or maybe NHS culture turns a blind eye to it. If you have, for example, a doctor who pretty much throws the papers you're meant to sign at you across the desk, slams the door when he walks in, rolls his eyes when you start crying because you're suicidal, calls nurses "stupid" behind their back, etc. because he is in a bad mood (as my aunt encountered in a hospital) do you think that's not going to affect how willing a patient is to share their problems, open up, etc.? Or, if you have a doctor who doesn't listen, you think that won't affect the treatment they provide?

    I am not going to disclose too much about where this was but my aunt had mental health problems btw, serious depression which he was meant to be helping with. Nor is she rude to people like doctors. I also have friends and relatives who've had similar experiences with different medical staff/hospitals, so it's not just one person. This is not true of all or even most of the NHS (I can say having been to hospital myself) but it's certainly a problem
    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 certainly not "superficial." Yes all industries have rude people, but unfortunately some (not all) NHS workers seem to think that they are above having to be polite to people because they work in an important area (healthcare) and are public sector workers too. At the end of the day, they may not be in the private sector but our taxes pay their wages so it's not like they're "working for free" or not working for us in a sense. When you're in a customer facing role, politeness is not superficial. I don't pay the guy at my local garage to be nice to me as well as service my car (servicing it is pretty much like healthcare in that if he makes a tiny mistake it could kill me) but if he does a great job servicing it and is also a total **** to me his boss is hearing about it and he knows it. Similarly, I can go to Tesco's and the kid on the till chucking my shopping at me before I leave isn't going to affect the food at all but I wouldn't call it "superficial" either.

    FYI, I'm pretty left wing as mentioned in this thread and support the NHS as a whole, but even if you are a "higher up" in a place like a bank or other private firm and a customer complains about you being rude, you will be called out on it. (There's a reason the tabloids make a big deal out of it when companies respond rudely to complaints about customer service - because it's so rare). I haven't been to university yet, but I've worked across a wide range of industries as I'm older than most on TSR and if I had ever been rude to a customer that way I would have expected to have gotten a good warning instead of my boss covering my behind and making excuses for me to said customer. And NHS patients are still "customers," even if it is free at the point of service.
    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.

    I'm considering applying for medicine as a mature student and doing my research on it. I am being put off by the numerous tales one hears of senior doctors and nurses being rude to other members of staff, including junior doctors/med students, even bullying them.
    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.

    For the record, my aunt complained and she got the old "we're sorry if you're offended, Dr X and all the staff here work very hard to provide an adequate standard of care" BS back in a letter and no other mention of any action that would be taken. She emailed back asking if anything would be done about the doctor (I actually helped her write this because she's not so good with computers) and got a reply so full of misspellings/typos etc. it seemed deliberately done to put her off, saying that they had "taken her comments on board." She sent another enquiry and got no response, after which she gave up. I can dig up a fair few links showing patient dissatisfaction with the NHS complaints system if you like. It being "mandated" to take patient complaints seriously doesn't seem to have had much effect in practice. Sometimes the NHS just seems to close ranks and cover up stuff.
    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.

    Also, are you considering GP complaints or just those made about hospital staff?
    Both I guess.

    And how are complaints actually resolved? What does taking them seriously even mean in practical terms? I'd be very interested to know how common cases like my aunt's are. Does it just "go on someone's record" even if a doctor or nurse says, no, I wasn't rude to that patient who complained about me, and the NHS succeeds in its attempt to pressure the patient into dropping the complaint or not pushing it any further? What if it's a particularly "valuable" member of staff (say, working in an understaffed department?), are the NHS more likely to take their side? Will the hospital just remove the complaint if they think it's without merit?
    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.

    Again, sources? (esp. on mostly governed on whether the doctor was polite).
    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.




    I only wrote a few sentences which you've expanded on quite a bit, but to cut this down I agree that if a doctor actually feels a patient doesn't need X treatment/a longer stay they shouldn't give it to them.

    With respect I would disagree on the whole "terrified" thing though. . Been reading the odd blog by "anonymous" hospital doctors, etc. Again, I don't exactly disrespect them or I wouldn't even be considering applying for medicine, but a lot of them seem to downright look down on patients. (e.g. that Confessions of an A & E SHO one). Maybe it's mostly senior ones but if you have an attitude like that it probably shows.
    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.

    I'm not talking about doctors/nurses necessarily here, but people like NHS managers/non front-line staff too.

    You are speaking from the perspective of a doctor. There's brief and then there's being a bully because you're having a bad day due to Jeremy Hunt being a **** and thinking you can get away with being rude to the ill person you're being paid to treat.

    Also, let's be real here. Nobody except the 1-2% of really oversensitive people, or the sort who would think it OK to assault a doctor if they were angry, complains because their doctor "didn't pat them on the back telling them everything would be OK." A lot of the time somebody IS actually being disturbingly rude or dismissive, and that's not "superficial," as I explained above. Again, healthcare is an important service but it's also a customer facing one and being polite to customers is part of providing that service. It's not about being a lap-dog like a car salesman, it's about respect going both ways.
    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.

    For the record, I support the junior doctors striking etc., but how does cutting their salaries affect privatisation directly? (Obviously, one can see how having them leave the NHS might affect it indirectly)
    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.

    Not necessarily. Maybe it's my perspective but obviously things like cancer screening etc. are pretty important, whereas (IMO) things like having a sprained ankle and being given the wrong advice/having dandruff misdiagnosed as psoriasis (happened to me) are not the end of the world.

    http://www.bbc.co.uk/news/uk-england...shire-30520897

    Still working at the hospital (in a different department but doesn't say which)

    http://www.dailymail.co.uk/health/ar...-hospital.html
    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/articl...?id=4294968656

    Just look at what happened to Edward Snowden!
 
 
 
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