A Tale of Two Deaths – NHS and Private Health Care

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Some years ago, two good friends died within a few months of each other … M (female aged 63) in the plush surroundings of the private wing of a London Hospital…. the other, P (male aged 56) in a NHS hospital in the Wirral.   Their personal circumstances could not have been more different.   M had a very comfortable, successful professional life whereas P was one of Thatcher’s casualties, consigned to the benefits scrap heap and unemployed since the 1980s.

I’m write now, because the manner of each of their deaths offer such a vivid picture of why we need to fight for the reinstatement of the NHS and a National Care Service… why privatization and financialisation of our health needs lead to the two tier contradiction of too much for those who can pay and too little for those who can’t.

M became increasingly ill with ‘a mystery’ illness only a few months before her death.   Eventually, she was admitted onto the private wing of a vast NHS hospital, in one of the wealthiest areas in central London. When I visited, I waited on leather bound settees, in a plush carpeted area decorated with original art works on the wall and filtered coffee on tap.

I have no doubt that M received state of the art medical treatment in her palatial room, with magnificent views over the London skyline.   However, when I last saw her, she was desperately phoning her husband to get onto the private health insurer because they had refused to fund the treatment that her consultant wanted to prescribe.

This was only two weeks before her death. She lay prone in her bed, with oxygen feeding into her nose. Her skin colour perfectly matched that of her white sheets. But, nevertheless, she was forced into worrying about the funding for her treatment because it was above that which the private insurer could authorize and ‘their special committee would not be able to consider the claim until after the weekend’.

I watched on, as she tried to explain over the phone to her husband that he needed to make the health insurer understand the urgency of the situation. Her desperate husband asked if they couldn’t just pay for the treatment outright. ‘No’ explained M. ‘The consultant says that any additional payments would invalidate the insurance plan and the insurers would then withdraw all payments for the hospital room and her care’.

I cannot describe my horror at the situation.

 

In contrast, P received the most extraordinary surgery and expert care in his NHS hospital without any financial limitation.   Through a freak accident, he had managed to dislocate his shoulder and somehow ruptured his oesophagus… I never got a very clear picture of how. Nevertheless, many weeks after 3 hours of surgery and a 3’ long incision spiraling around his torso, he had ‘recovered’ sufficiently to be sent home.

P lived alone, had had major surgery and yet there was no aftercare… no follow up. An extremely elderly neighbour (without a car) did a bit of shopping for him and that seemed to be it.

P was a highly intelligent, well-read socialist… a friend, made online.   We never actually met… so I cannot give the details as to why he did not receive help from social services or health checks from his GP… but I know that I made him contact the doctor after a few weeks when he confessed that he couldn’t eat and whenever he drank anything, it burned his whole insides!  That was the first time that he’d seen a doctor since leaving hospital.

Unfortunately, his oesphagus had split again and he was re-admitted to hospital for more expensive surgery. He lingered on for a few weeks before finally succumbing to a lung infection from which he eventually died.

I am not for a moment suggesting that either of these two deaths resulted from medical negligence.

But sumptuous surroundings are no compensation for the additional nightmare of exceeding your insurance policy’s spending limits…

And, there is little point in state of the art surgery if there is no aftercare in the community.

Under the Tories (with the help of the LDs in coalition) we are inexorably moving towards the two tier system of the US even though they spend more per capita on health and have worse outcomes.

The truth is that when there is a profit motive, the rich are over-investigated, and the poor are under-treated.

Stuart Hall despaired, in 2012:

“How can millions of people have benefited from the NHS and not be on the streets to defend it? Come on. The NHS is one of the most humanitarian acts that has ever been undertaken in peace time. The principle that someone shouldn’t profit from someone else’s ill health has been lost. If someone says an American health company will run the NHS efficiently, nobody can think of the principle to refute that. The guiding principles have been lost.”  https://www.theguardian.com/theguardian/2012/feb/11/saturday-interview-stuart-hall

 

Today’s demonstration may be later than he wanted but the many thousands turning out to march today must have pleased Stuart Hall.

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The Labour Party under Jeremy Corbyn pledges:

‘We will end health service privatisation and bring services into a secure, publicly-provided NHS. We will integrate the NHS and social care for older and disabled people, funding dignity across the board and ensure parity for mental health services.’

http://www.jeremyforlabour.com/pledges

The only question is what sort of health service will we be left with after 10y of Tory asset-stripping?

 

The Left Must Reform Public Services Too

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The most feared word to our public services is reform.

Reform has become a by-word for cuts and privatisation. Take, for example, the NHS reforms currently going through Parliament, or the changes to DLA. Both are ideological changes designed to privatise one and simply reduce payments to the other.

However, while fighting these reforms, the left cannot rest on their laurels. Our public services do need reforms, but not the ones offered by the Coalition. They are needed to better serve the need of service users, in a way that maximises precious resources. They are needed to reaffirm to the United Kingdom that public services are the most cost effective way of delivering vital services, with the best outcomes for service users. Without changes, those forces that are pushing for privatisation will gain a stronger and stronger voice.

A major issue is the lack of intermediate community care. I have recently experienced this with a relative who is elderly suffering from early dementia and a heart condition. In the last 6 months she has been hospitalised around 10 times. Her heart condition and dementia are beyond the scope of her GP as her needs are complex. However, as there is no provision for community care, this resulted in her worsening on a number of occasions to a degree that required hospitalisation. This is invariably expensive and can result in people getting help when it is too late, so the intervention is less successful.

This is common with conditions like diabetes too. If managed in the community by more specialist community care teams, it is substantially cheaper than hospitalisation with much better patient outcomes. It would preserve hospitals for those matters that only they can handle.

We need to wean ourselves from too much concentration on hospitals. Many local hospitals provide a skeleton service, when nearby there is a larger, more equipped hospital with better specialists available. People do love their local hospital, but I believe diverting resources partially to bigger hospitals and to community services from local skeleton hospitals would result in better health care at a lower price.

Another area where co-ordination is poor is that between the NHS and social services. From September to October 2011 128,000 days delay were incurred by the NHS because of bed-blocking – when patients can’t be discharged as the services they need are not in place in the community [1] . This figure had been falling, but the impact of cuts to local social services budgets has reversed the figures. Each day in a hospital bed costs an average of £255. Therefore, the cost to the NHS of 128,000 days of delays amounts to nearly £33 million, annualised to nearly £196 million. This far exceeds the cost of providing care in the community.

In the last year or so, my Son has been going through the system for a diagnosis for a condition on the autistic spectrum. Quite frankly, no-one would believe how dreadfully poor this service is, and how badly under funded these services are. In this battle to find the required support at school, we are on our third school in year. Read any of the forums about parents battling this, and you get the same story time after time. It’s a national scandal every bit as poor as our national treatment of the elderly. The reform required here is a large increase in funding, much better training for teachers and a smoother journey between the different professionals involved.

Education services require reform too. Schools are in an excellent position to pick up problems with children who without intervention are likely to grow up into uneducated, workless adults who are at risk of getting involved with crime. Early intervention is far cheaper, as the right investment will be likely to produce a law abiding taxpayer. Without intervention the cost of benefit payments, the cost to the justice system, and most of all the personal cost, it is crazy to not intervene early. The transfer of resources from the justice system to the education system deals with the root cause and not the symptoms. The Coalition have promised to help 120,000 families at most risk, but this is not enough.

All this co-ordination and improvement is impossible with broken up and privatised services. The left should argue that these reforms are required and in the best interests of the country. Only a reformed truly public sector can deliver this.

Sources

[1] http://www.bbc.co.uk/news/health-15198431