by Dr. Iain Corness
Healthcare - as proposed by politicians
In one of my previous lives I worked in
the UK, both in general practice and also a stint as a House Physician in an
NHS hospital. Those years were not a highlight of my medical life.
Like all national health schemes in any country, the British NHS was
similarly underfunded, understaffed and overused. I am led to believe that
the same description applies.
I received a document this week from the UK government stating the
improvements that are going to happen in the NHS. Proudly it began with
“Millions of people will now be able to see their family doctor outside of
working hours, including late night and weekend appointments, while the
elderly and those with more serious health complaints will get tailored
care, coordinated by just one local GP.” It went on to say “More than 7.5
million people in England will be offered increased access to their GP
services, including seven-day opening and 8 a.m.-8 p.m. appointments.”
Nice promise, the personalized care for the most vulnerable - 800,000 people
with the most complex needs, mostly aged over 75, will also be enrolled onto
a separate Transforming Primary Care program of proactive, personalized care
in the community. These patients will be offered a proactive enhanced
service including: individual care plans reviewed regularly with patients
and carers by GPs, nurses, and other health professionals; a named GP
responsible for their care; and same-day access to a GP when they need it.
Sounds good - but will it work?
Let’s look at the tailored health care for the elderly and those with
serious complaints, coordinated by a local GP. Sorry, but this just cannot
work. When I worked in the UK we had the “Emergency Bed Service” coordinated
by one hospital physician. The idea was that physician would organize a bed
for patients requiring in-patient care. The local hospitals would let the
Physician know how many vacant beds they had and the clever coordinator
would select the best hospital for that patient’s needs. Great idea, except
that it didn’t work.
Reality was that every hospital would claim they were already over-full, so
the Physician had no choice other than to have a bed put up in the corridor.
Today’s “Tailored healthcare for the elderly” will go the same way.
The government proposes 8 a.m. to 8 p.m. opening hours for surgeries. That’s
a 12 hour shift for the local GP. No-one else in the UK works 12 hour
shifts, so the only way around this will be with co-opted doctors from
Europe to keep the surgeries open. Forget about the extra costs involved and
you can forget about having “your” doctor to look after you.
I have mentioned the waiting lists for non-urgent surgery recently, but the
problems we faced years ago are still there today. The situation was quite a
few years ago when I had to put people on a waiting list, but it is still
the same today. In fact, more than a quarter of people with long-term
conditions in the UK say they are not well cared for by the NHS, and
two-fifths say they expect their care to get worse over the coming years.
Unfortunately for those experiencing discomfort and pain, particularly with
orthopedic conditions, to be told that they need a new hip, but the waiting
list is some years, no wonder the older members of the population feel
depressed and not cared for.
Now you may be wondering why I mention all this. Quite simply because I like
to point out just how lucky we are here in Thailand. With my hospital’s
waiting list times in hours and access to doctors 24/7 we are very
If you have relatives overseas who are on a waiting list (hoping that the
person above them on the list quietly dies, moving them up one notch),
coming over here as a medical tourist might be something you should
consider. Sure, the NHS in the UK does not require payment at the point of
service, and we are a private hospital which charges fees (incidentally much
cheaper than private hospitals in the UK), but how do you put a price on
early relief of pain? Food for thought?