About Archive Tags RSS Feed


A diversion - The National Health Service

31 August 2014 21:50

Today we have a little diversion to talk about the National Health Service. The NHS is the publicly funded healthcare system in the UK.

Actually there are four such services in the UK, only one of which has this name:

  • The national health service (England)
  • Health and Social Care in Northern Ireland.
  • NHS Scotland.
  • NHS Wales.

In theory this doesn't matter, if you're in the UK and you break your leg you get carried to a hospital and you get treated. There are differences in policies because different rules apply, but the basic stuff "free health care" applies to all locations.

(Differences? In Scotland you get eye-tests for free, in England you pay.)

My wife works as an accident & emergency doctor, and has recently changed jobs. Hearing her talk about her work is fascinating.

The hospitals she's worked in (Dundee, Perth, Kirkcaldy, Edinburgh, Livingstone) are interesting places. During the week things are usually reasonably quiet, and during the weekend things get significantly more busy. (This might mean there are 20 doctors to hand, versus three at quieter times.)

Weekends are busy largely because people fall down hills, get drunk and fight, and are at home rather than at work - where 90% of accidents occur.

Of course even a "quiet" week can be busy, because folk will have heart-attacks round the clock, and somebody somewhere will always be playing with a power tool, a ladder, or both!

So what was the point of this post? Well she's recently transferred to working for a childrens hospital (still in A&E) and the patiences are so very different.

I expected the injuries/patients she'd see to differ. Few 10 year olds will arrive drunk (though it does happen), and few adults fall out of trees, or eat washing machine detergent, but talking to her about her day when she returns home is fascinating how many things are completely different from how I expected.

Adults come to hospital mostly because they're sick, injured, or drunk.

Children come to hospital mostly because their parents are paranoid.

A child has a rash? Doctors are closed? Lets go to the emergency ward!

A child has fallen out of a tree and has a bruise, a lump, or complains of pain? Doctors are closed? Lets go to the emergency ward!

I've not kept statistics, though I wish I could, but it seems that she can go 3-5 days between seeing an actually injured or chronicly-sick child. It's the first-time-parents who bring kids in when they don't need to.

Understandable, completely understandable, but at the same time I'm sure it is more than a little frustrating for all involved.

Finally one thing I've learned, which seems completely stupid, is the NHS-Scotland approach to recruitment. You apply for a role, such as "A&E doctor" and after an interview, etc, you get told "You've been accepted - you will now work in Glasgow".

In short you apply for a post, and then get told where it will be based afterward. There's no ability to say "I'd like to be a Doctor in city X - where I live", you apply, and get told where it is post-acceptance. If it is 100+ miles away you either choose to commute, or decline and go through the process again.

This has lead to Kirsi working in hospitals with a radius of about 100km from the city we live in, and has meant she's had to turn down several posts.

And that is all I have to say about the NHS for the moment, except for the implicit pity for people who have to pay (inflated and life-changing) prices for things in other countries.



Comments on this entry

icon -dsr- at 14:00 on 31 August 2014

Do any of the NH systems run Urgent Care centers?

I started seeing Urgent Care centers about the turn of the century. Urgent Care is a level in between a general practitioner's office and an emergency center. They don't make appointments, they don't handle "wellness" visits or preventative care, they don't treat long-term illness.
If you come in and should be sent to an emergency ward, you'll be transported immediately; Urgent Care isn't set up to deal with traumatic injuries.

For everything in between -- sudden fever, bad bruising, odd infections -- Urgent Care sees patients as soon as possible, always the same day, taking stress off of emergency centers.

icon Steve Kemp at 14:04 on 31 August 2014

That's not a term I recognize, so I'm not sure to be honest.

I know that a lot of folk who come in to A&E are pretty much filtered into "urgent" cases who are seen immediately, "non-urgent" who are essentially sent away and told to make an appointment with their local doctor, and some people who are in the middle and get rerouted to different departments for treatment/care.

icon Miguel at 10:16 on 3 September 2014

I guess part of the problem with paranoid parents saturating A&E is the difficulty of accurately communicating with their child, plus a lack of experience. The lack of experience is certainly an issue at my home, even if both my parents are actually MDs (in a different country, thanks Skype!)

Additionally, I doubt most people are aware of the "off-hours GP service", where you can get a weekend appointment in a hospital for, say, your child's amigdalitis on a saturday as opposed to an endless wait in A&E for something that really isn't an emergency.

My main complaint on the NHS is however the lack of information I routinely get from GPs. It's like it hurts them. In my experience, NHS is one of the places where insisting you are Dr. and not Mr. will get you a better deal.

And one final remark with respect to the price: most people aren't aware of the true cost of healthcare. The Basque Country budgets around €2.000/person/year for its healthcare system, which I guess is comparable in quality & density to NHS. Insurance companies probably charge much more than that to risky "customers".