Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Grateful to the NHS
- Paul M J Verheecke (3 September 2004)
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The old order changeth
- John Hopkins (3 September 2004)
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THANK YOU FOR THIS
- Graeme M Mackenzie (3 September 2004)
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Are britons getting their money`s worth?
- ramesh donepudi (6 September 2004)
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International statistics on patients' experiences might add perspective
- Rob Anderson (6 September 2004)
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All Britons (and some others) should be grateful for the NHS
- L-F Ng (6 September 2004)
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Must the financial bottom line dominate decisions about the future of the BMJ?
- Iain Chalmers (6 September 2004)
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Because sensationalism sells !!!
- LEKSHMI PREMKUMAR, Prem K Kunjukrishnan; SpR in Old Age Psychiatry (6 September 2004)
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Americans should be so lucky
- Julie N. Broderick (7 September 2004)
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Re: Because sensationalism sells !!!
- Jenny Sheridan (8 September 2004)
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Re: Are britons getting their money`s worth?
- Tom Marshall (9 September 2004)
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Defend the independence of the NHS
- Millie Kieve (9 September 2004)
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Hidden treasure
- Srinivasan Ravi (9 September 2004)
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Paul M J Verheecke, Chemical Pathologist LBS lab, B-1050 Brussels, Belgium
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So, britons should be grateful to the NHS because it is still worse in Armenia ? Amazing ! Competing interests: None declared |
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John Hopkins, GP Newton Aycliffe DL5 4SE
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Dear Ms Smith, This article contains no advice to doctors to pull their socks up. Furthermore you have started publishing articles about clinical medicine. What is going on ? John Hopkins Competing interests: None declared |
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Graeme M Mackenzie, GP Whitehaven CA28 7RG
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What is it about human societies that criticise systems that involve honest, good, thoughtful and intelligent hard work on the basis of the failings of that system. Do they expect perfection? Sometimes I feel that modern societies are at the beck and call of an grossly, irresponsible media (where the uniformed opinion of pampered columnists becomes "fact") read by the masses who have little idea of or respect for what real complex responsibility means in terms of health care. This would apply to education systems as well. This constant highlighting of failings results in hard working, well motivated people losing their professional self estem and pride in their organisation. That of course results in more failings. Thus the neandertal criticising of complex systems in modern societies becomes the actual cause of the system's failures. A bit more respect, a more responsibile media, some more basic education about the processes of life and the options available for managing life's inevitable health problems and appropriate expectations could transform the whole moral of the NHS and the satisfaction of its users. Combine this with a less litigous society and a willingness to wait and see a bit before ordering endless tests and investigations and we indeed have the makings of a revolution. Competing interests: None declared |
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ramesh donepudi, SpR Walsall NHS Trust, Walsall, WS2 9PS
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Having lived and worked in the United States, I strongly disagree with the notion that one cannot trust the intentions of private health service providers . Infact they are as caring and the attitudes as pure as they are here. Further the monthly medical insurance I paid for my entire family was far less compared to the national insurance me and my wife pay ( I understand part of it goes towards other public funding ). I never had to wait to see a specialist or have an investigation. The concept of co-pay i.e paying an intial amount towards the treatment costs didn`t sound as bad either. After all, why should people who are using the service less frequently pay more. Though NHS has a very socialist motive, I am not sure an average working middle class briton is getting their money`s worth. There is a strong need for more choice indeed in NHS. Competing interests: None declared |
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Rob Anderson, Senior Research Officer Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW 2007
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I applaud Jane Smith for highlighting the positive, effective and wonderfully caring nature of most NHS encounters (Editorial 4 September 2004). Health-system-bashing by the news media is sadly not just a British phenomenon: here in Australia, as in most industrially advanced countries it seems, the newsworthiness of the health system typically means endless stories about failing hospitals, people waiting for operations, supposed under-funding, and either corrupt or incompetent doctors. These stories in turn fuel a recurring general theme of a system “in crisis”, or at least one that is very poorly managed. In contrast, positive health stories are almost totally restricted to what doctors or, more often, clinical researchers do: magic bullet “wonder drugs”, and “ground-breaking” treatments or technologies. A few international comparative statistics about patient-reported experiences of health care might go some way towards more positive and balanced health system stories about the NHS. For example, in the UK a tiny 3% of people avoid consulting a doctor due to cost – compared with 24% in the US, and 11% in Australia.1 Also, whereas in the UK there is virtually no difference in this statistic whether people are sick or well, or rich or poor, in Australia, Canada, New Zealand and especially in the US, being poorer or sicker means you are much more likely to avoid seeing a doctor due to cost. Even NHS dentistry – despite wide geographic variations in its accessibility and almost universally negative media coverage – seems to make an impact: while less than a fifth (19%) of people had not consulted a dentist due to cost, there is almost no difference in this statistic between those on low and high incomes (20% and 19%). Why do important statistics like these, about actual patient or family experiences of health care when they needed it, remain so unpublicised? And to counteract the pervasive negativity in the media why shouldn’t the NHS or Department of Health run self-promotional campaigns – much like the BBC did a few years ago – to directly publicise how mostly very well it works; how often other health systems want to emulate NHS practices and policies (NHS Direct, primary care collaboratives etc.); and how it is funding through general taxation that allows so much of this potential and actual improvement for patients? 1. Blendon, R., C. Schoen, C. DesRoches, R. Osborn, K. Scoles, and K. Zapert. Inequities in health care: a five-country survey. Health Affairs 2002. 21 (May/June 2002): 182-191. 2. Blendon, R., C. Schoen, C. DesRoches, R. Osborn, and K. Zapert. Common concerns amid diverse systems: health care experiences in five countries. Health Affairs 2003. 22 (May/June 2003): 182-191. Competing interests: None declared |
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L-F Ng, Staff Medical Oncologist & Senior Lecturer in Medicine Ballarat Hospital, Ballarat, VIC 3350, AUSTRALIA
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Thank you Dr Jane Smith for your candour. I qualified and 'grew up' in the NHS but found it intolerable during the Thatcher era and I left. After an absence of 20 years and into my mid career, I returned as there appeared a new sparkle in some of the plans (in my particular case the National Cancer Plan) I had to get my past non UK training assessed to get my name entered into the GMC Specialist Register, and in good faith, I did and was successful. I was very patient with the first Trust I worked in. Life could not have been that bad as a locum consultant, I thought - so I moved on. After having worked in another 2 different Trusts in different parts of the Kingdom, I decided that the NHS had made me age faster and even more stressed in the 2 short years I was in the UK. The major issues were that no one appreciated one's hard work; some patients abused the complaints system to no end to get what they wanted; some colleagues had well hidden vested interests (privately administered chemotherapy regimes differed greatly from those in the (guidance or governance enforced) public system); heavy work loads made it impossible to properly communicate even though one was fluent in English; the name, blame and shame culture exists everywhere (even for innocent bystanders); discrimination of sorts is alive and well - and so on... Nonetheless, I am thankful to the NHS for having given me all the experience I needed for where I work today. No system is perfect but for socialised medicine with the greatest constraints, this is an exemplar (when properly managed by administrators and when not abused by patients) Modern day Britons (like elsewhere) have choices between the private and NHS sectors, and now, with cheap airfares, the whole of the EU. The system allows interchange between the two unlike in many other countries where "punitive" attitudes exist. So, why should they complain when it is inappropriate to do so? Why should a hospital be metaphorically moved to the proximity of a complainant's remote "castle"? But, for me, I prefer to keep away. Thanks but no thanks! Competing interests: None declared |
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Iain Chalmers, Editor Summertown Pavilion, Middle Way, Oxford OX2 7LG
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I am submitting a response to the 'Editor's Choice' column in this week's BMJ only because I cannot identify an alternative route for commenting on the front outside cover of the current issue. This is a 2-page fold out advertisement for a drug, with the journal's cover page on the reverse side. This is unprecedented in my experience of reading medical journals. This symptom of drug promotion apparently beginning to take over the BMJ comes on top of a recent decision that the journal must introduce charges for electronic access, thus undermining the world's most lively forum for debate on medical matters. I was one of the promoters of a motion at this year's ARM proposing that bmj.com should remain free as long as the BMJ publishing group is in profit. Although selected for the agenda, the motion was not debated. This week's issue suggests that further nails are being driven into the coffin of a journal which has achieved immense popularity throughout the world, and that the financial bottom line is inexorably trumping all other considerations about the BMJ's future. I am one of tens of thousands of people around the globe who regards the BMJ with great affection as well as respect. I have the impression that there is insufficient recognition within the BMA that the Association has acquired reflected kudos as a result of its support of the BMJ's initiatives and content over recent years. Although it is impossible to put a cash value on this kudos it should be cherished and protected at a time when the profession is coming under public attack from a number of quarters. I have the strong impression that it is being unceremoniously jettisoned. Iain Chalmers, Editor, James Lind Library (www.jameslindlibrary.org) Competing interests: None declared |
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LEKSHMI PREMKUMAR, Trust Grade in Psychiatry Dewsbury & District Hospital, Prem K Kunjukrishnan; SpR in Old Age Psychiatry
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Editor, Sordid tales sell and therfore, sensationalism is, pretty much, the name of the game as far as the "popular" ( or is it?) press is concerned.Thanks to the media, we have turned into a nation of cynics, sceptics, scare -mongers and witch-hunters with a fine sense of "scape- goating".Good news no longer interests us. Times have certainly changed from "no news is good news " to " bad news is the new good news"!!! A huge and complex organisation such as the NHS, is bound to have difficulties in its day to day functioning. To keep the NHS moving with the times,there has been a steady stream of reforms,through the years, to change the way the NHS functions. While the press have a duty to inform the public of its failings and facilitate the appeal for improvements, it seems to gone about this in a scare-mongering manner. One rarely sees any press article praising the NHS or its staff. Think of the thousands of patients who are treated everyday and who leave with goodwill and gratitude.But none of these stories ever break out into the realm of public consciousness. Nothing can be more demoralising to frontline staff than to hear the NHS being pilloried for its failings rather than being celebrated for its successess. Too much of these negative vibes, and soon the NHS staff will believe that they are on a sinking ship that is on its way to nowhere. And this is already happening. It will be sad to see such a monumental institution being done to death by a few careless strokes of the pen which needs to have a better understanding of the organisational complexities and the lives of the people who live out the ideals of the NHS Competing interests: None declared |
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Julie N. Broderick, Medical device company executive 01801
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The juxtaposition of this editorial on the NHS with the news item on the increase of Americans without health insurance highlights the value of the NHS. While Britons may bemoan waiting lists and perceived inadequate care from the NHS, they should be thankful they have unfettered access to decent medical care when they need it. In comparison, 45 million Americans have no health insurance and are just one car accident or serious illness away from financial ruin. Emergency rooms, particularly in the cities, are overrun with uninsured patients who have nowhere to go for routine medical care and end up in the ER when their illnesses progress. Sadly, there is no political will in the U.S. to institute a national health care service or even a national health insurance program. This leaves millions of Americans in fear of losing their jobs and their health insurance. Competing interests: None declared |
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Jenny Sheridan, User involvement facilitator Kensington & Chelsea PCT, 125 Old Brompton Road, London SW7 3RP
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My experience of the NHS and that of my partner and almost all my friends, is overwhelmingly positive. Staff are on the whole perceived as both competent and caring, especially when the injury or illness is severe or acute. I will always be grateful to the doctors and nurses at Chelsea and Westminster Hospital who looked after my mother -and us, her family - when she was dying. Not only is it a good service, it's a fair one. It cares for the poor, the rich and the in-between, unlike the system in the US and some other countries that could afford to do more. So why the unrelenting bad press? Newspapers do concentrate on bad news generally, not just in relation to health care, but the NHS gets it in the neck constantly, with the impact on morale that other correspondents have outlined. Is there a hidden agenda here? Do newspaper proprietors or editors or columnists have shares in private helath care providers? Is there a need for a bottom-up organisation to support the NHS and to counter the bad press? Competing interests: None declared |
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Tom Marshall, Senior Lecturer in Public Health University of Birmingham B15 2TT
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Dr Ramesh Donepudi's reply exemplifies one of the problems with the US system of health insurance. Most ordinary employees do not know what it costs. Health insurance for a family costs in the region of $1600 per month (almost $20,000 per year). Most of this is paid directly by the employer, so the employee is only aware of a deduction of a few hundred dollars from their monthly salary. Many employees (like Dr Donepudi) believe this is all they pay. In fact the USA spends nearly 15% of its GDP on healthcare. Government spending is 7% of GDP (similar to the UK in percentage terms, but larger in dollar terms). This is accounted for by programmes such as Medicare (the elderly), Medicaid (the indigent), the Veterans Administration and in the form of tax exemptions for employers payments to private insurers. The US government therefore spends more per capita on healthcare than the UK government and still manages to leave 45 million uninsured and a further 50 to 60 million underinsured. Competing interests: None declared |
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Millie Kieve, Chair of APRIL Abridge RM4 1UA
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Jane Smith defends the basic equitableness and decency of the NHS and many people would agree. To Jane's view that Britons should be grateful for the NHS should also be added an appeal for the medical profession to maintain the independence of the NHS. The ABPI are announcing a framework that will "help the NHS and the pharmaceutical industry to work In partnership", they say, "to help patients". In the light of the complaint made by the Royal College of General Practitioners about pharmaceutical company disease promotion leading to over-prescribing of medication, one wonders where a closer partnership with the industry will lead. It is not too late for clinicians or anyone with concerns about this kind of influence to submit an email to the House of Commons Health Committee Inquiry into the Influence of the Pharmaceutical Industry. Just email the committee at: healthcommem@parliament.uk The first oral session takes place today Thursday 9th September but they are still accepting submissions from the medical profession or anyone else with evidence for this very important inquiry. Competing interests: Chair of APRIL charity (Adverse Psychiatric Reactions Information Link)www.april.org.uk |
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Srinivasan Ravi, Consultant Surgeon Blackpool
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I cannot understand the criticism of the NHS. I can only surmise, that it is due to the total inexperience of the critical experts or alternatively their lack of experience of other health care systems in the world. My relatives from the US could not believe their experience in the UK and went away with a completely different opinion of our health care. When their child had an acute asthmatic attack, he was seen and treated rapidly and as he was only 11 years there was no charge. In the US and Canada, I understand that there is not only a charge but to dispense ventolin there is a further pharmacy charge. They pay $35 for ventolin, which here on a private prescription cost four pounds. By the same token, my family member who was admitted to the intensive care in Florida whilst visiting his daughter, had to pay 60,000 dollars for medication which was not covered by his insurance. The term RIP off springs to mind. The system is inefficient to the core in the US and the press appear to praise it. They spend more money on health care because of duplication - for instance, a person with a shoulder fracture will be seen by the consultant in A&E, then by a vascular surgeon who will ensure that there is no vascular injury and place central lines; he will then refer the patient to an orthopaedic surgeon. The patient's insurance company will have paid $600 plus prior to actual delivery of care by the appropriate specialist. No wonder, it is expensive. I cannot understand why a certain degree of rationing is not acceptable when care of an exceptional quality, compared to the rest of the world is provided, urgently when needed and rationed when not urgent. The cost is then be kept at an acceptable level. I love the NHS. Sure, there are things that need to be improved and there always will be. We must reflect on what we have - a wonderful gift to the people of this nation. Let us be aware, that by too much criticism we may kill the GOLDEN GOOSE. Competing interests: None declared |
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